Monday, 3 September 2018

Tutorial 3 September 2018




41
EMQ. Risk management.
42
Viva. Risk management
43
Role-play. Complaint. Mis-filed combined Ds test report.
44
Role-play. Teach breech delivery
45
Viva. Diathermy

41. Risk management. EMQ.
Lead-in.
The following scenarios relate to risk management / disciplinary procedures.
Pick one option from the relevant option list.
Each option can be used once, more than once or not at all.
Abbreviations.
DOH:    Department of Health.
FY:         Foundation year trainee
Option list 1.
A.             allow the practice to continue
B.             stop the practice until a full investigation has been done
C.             stop the practice permanently
D.            arrange an investigation by a senior consultant from another hospital
E.             decide the practice does not involve added risk
F.              declare the risk to be acceptable
G.            cancel admissions for surgery
H.            arrange adverse incident analysis
I.               arrange audit
J.               arrange research
K.             arrange a formal warning for the doctor
L.              arrange retirement for the doctor
M.          arrange dismissal for the doctor
N.            consult the on-call consultant
O.            consult the Clinical Director
P.             consult the Educational Supervisor / College Tutor
Q.            consult the Medical Director
R.             consult the Chief Executive
S.              consult the Postgraduate Dean.
T.             consult the hospital’s lawyer
U.            write to Her Majesty at Buckingham Palace
V.             consult your Medical Defence Body
W.          consult the British Medical Association
X.             consult the RCOG
Y.             report the matter to the GMC
Z.              allow return to work
AA.        allow return to work, but offer support
BB.         arrange a “return to work” package specific to the doctor
CC.         none of the above
Option list 2.

  1.  
call for help from the senior midwife

  1.  
go back to the labour ward and pretend that nothing has happened

  1.  
go back to the labour ward and inform the senior midwife

  1.  
phone the GMC

  1.  
phone the on-call consultant anaesthetist

  1.  
phone the on-call consultant obstetrician

  1.  
phone the police

  1.  
put the anaesthetist in the recovery position and remove the mask

  1.  
none of the above
Scenario 1
You are the Clinical Director. 1 62-year-old Consultant colleague has been off work for 8 weeks with a broken arm sustained in a skiing accident. He sends you a certificate from his specialist to say that he is now fit to return to work. He indicates that he wishes to return to work immediately. What action will you take? Use Option list 1.
Scenario 2
You are the Clinical Director. 1 62-year-old Consultant colleague has been off work for 8 weeks with a severe bereavement reaction to the suicide of a family member. He sends you a certificate from his GP to say that he is now fit to return to work. He indicates that he wishes to return to work immediately. What action will you take? Use Option list 1.
Scenario 3
You are the Clinical Director. 1 62-year-old Consultant colleague has been off work for 6 months after having a coronary thrombosis. He sends you a certificate from his specialist to say that he is now fit to return to work. He indicates that he wishes to return to work immediately. What action will you take? Use Option list 1.
Scenario 4
You are the Clinical Director. A 62-year-old Consultant has returned to work after four months’ sick leave after a coronary thrombosis. He has three cases on his first operating list and all have complications reported by the Sister on the gynaecology ward. What action will you take? Use Option list 1.
Scenario 5.
A Consultant has been in her first consultant post for two months. Three of the four patients on a single operating list develop post-operative wound infections. What action will you take? Use Option list 1.
Scenario 6.
You have recently been appointed Clinical Director. A consultant has been in post for ten years and prefers to operate with the same nurse assistant. No complications have been reported. What action will you take? Use Option list 1.
Scenario 7.
You are the Clinical Director. A consultant has an operating  list in a peripheral unit 20 miles from the main hospital. There is no resident doctor with post-operative care being provided by nurses. The cases dealt with on the list traditionally were minor, day-cases.  You have been told that the consultant, who was appointed 6 months ago, has recently been doing hysterectomies and prolapse repairs to get the waiting list down.  What action will you take? Use Option list 1.
Scenario 8.
You are the Clinical Director. The blood bank informs you that there is a problem with supplies and fully cross-matched blood cannot be guaranteed for tomorrow’s arranged surgical cases. What action will you take? Use Option list 1.
Scenario 9.
You are the on-call SpR. It is 8 pm. The blood bank informs you that there is a problem with supplies and fully cross-matched blood cannot be guaranteed for tomorrow’s arranged surgical cases. What action will you take? Use Option list 1.
Scenario 10.
An SpR is half an hour late for starting his duties on three occasions in one week. His consultant wishes to have this dealt with as a disciplinary matter to “nip it in the bud” and teach him a lesson. He reports it to you, the Clinical Director asking you to discipline the doctor. What action will you take? Use Option list 1.
Scenario 11
An SpR gets into an argument with the senior midwife on the labour ward and in the heat of the moment slaps her across the face. You are the Clinical Director and the matter is reported to you next day. Use Option list 1.
Scenario 12
Your consultant is the Clinical Director and a nasty man. You apply 6 months in advance for study leave for the week before the written part of the Part Ii MRCOG exam. He tells you that he plans to go on holiday at that time and you are not going to get any leave. In addition, he tells you that if you complain about this he will give you a terrible reference and tell all his consultant friends that you are a waste of space in order to ruin your career. What action can you take? Use Option list 1.
Scenario 13
A SpR fails an OSATS, but falsifies his records to indicate that it has been completed satisfactorily. You are the Educational Advisor and this is brought to your attention. What action will you take ?  Use Option list 1.
Scenario 14
You are the Clinical Director. A SpR2 uploaded reflective practice putting himself in a good light after a case which had been handled sub-optimally by him. What action will you take?
Use Option list 1.
Scenario 15
You are an FY2 and assist the senior consultant at a hysterectomy. The operation goes well initially, but then there is a lot of bleeding and a ureter is cut. The consultant urologist attends and repairs the ureter. The woman bleeds vaginally that evening and is taken back to theatre by another consultant and ends up in the ICU. You became convinced during the operation that you could smell alcohol on the consultant gynaecologist’s breath. What are your responsibilities? Use Option list 1.
Scenario 16
When do you need to inform the Consultant on-call? There is no answer on the option list – make your own list.
Scenario 17
When do you need to inform the Clinical Director? There is no answer on the option list – make your own list.
Scenario 18
When do you need to inform the Medical Director? There is no answer on the option list – make your own list.
Scenario 19
When do you need to inform the GMC? There is no answer on the option list – make your own list.
Scenario 20
What are the roles of the BMA and MDU? There is no answer on the option list – make your own list.
Scenario 21
What are the differences between verbal and written warnings? There is no answer on the option list – make your own list.
Scenario 22.
Lead-in.
You are the SpR for the delivery unit. During a quiet moment you head for the staff room adjacent to the operating theatre for a coffee. As you pass the anaesthetic room you hear loud snoring. You look in and find the on-call anaesthetic registrar unconscious on his back on the floor with an anaesthetic mask by his face attached to a cylinder of nitrous oxide.
What action will you take? Pick one option from option list 2.
Scenario 23.
Lead-in.
You are the SpR for the delivery unit. During a quiet moment you head for the staff room adjacent to the operating theatre for a coffee. As you pass the anaesthetic room you hear loud snoring. You look in and find the on-call anaesthetic registrar unconscious on his back on the floor with an anaesthetic mask by his face attached to a cylinder of nitrous oxide.
What action will you take next? Pick one option from option list 2.
Scenario 24.
Lead-in.
You are the Clinical Director. It is the morning after the events in scenarios 22 and 23.
The on-call consultant obstetrician comes to see you are reports what has happened.
What action will you take?
Option list.

  1.  
discuss the case with the Chief Executive

  1.  
discuss the case with the Medical Defence Union

  1.  
discuss the case with the BMA

  1.  
discuss the case with the Medical Director

  1.  
discuss the case with the most senior person in the personnel department

  1.  
discuss the case with the Postgraduate Dean

  1.  
report the anaesthetic registrar to the GMC

  1.  
resign from being Clinical Director to avoid stress

  1.  
summon the anaesthetic registrar to give him a severe telling-off

42. Risk management. Viva.
Candidate’s instructions.
This is a viva station. The topic is the principles underlying risk management.
The viva is unstructured: the examiner will not ask questions.
43. Complaint. Mis-filed combined Ds test report.
Candidate's Instructions.
You are the SpR in the ante-natal clinic. The consultant has been called to the labour ward to help with a case of placenta accreta and you have been put in charge of the clinic.
Mrs Jones had a “combined test” at 11 weeks which gave a risk of Down’s syndrome of 1: 40. The report had been filed in the notes in error by a clerk without being shown to any of the medical or midwifery staff. She attended today for the routine 20 week scan. The ultrasonographer found the report in the notes, realised that no action had been taken and sent her to see the midwife in the antenatal clinic. The midwife told her the result and made arrangements for the patient to see you today.

44. Breech delivery.
Candidate’s instructions.
You are the SpR on call for the delivery unit. It is still unusually quiet. The on-call consultant has been told that you did a brilliant job of explaining normal labour and delivery on a previous occasion. She has asked you to explain vaginal breech delivery to a new FY2, who is keen on a career in O&G.

45. Diathermy.
Candidate's Instructions.
This is a ‘structured conversation’ station about diathermy and its uses and complications.
The examiner will ask you 8 questions.
When you have completed an answer, you are not allowed to return.



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