Website
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26
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Roleplay. Pre-pregnancy counselling.
Phenylketonuria
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Structured
discussion. Write a protocol.
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28
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EMQ. Risk management
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29
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EMQ. Kangaroo care.
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26.
Roleplay. Pre-pregnancy counselling. Phenylketonuria
Candidate’s instructions.
You are the SpR in the pre-pregnancy clinic. Your
consultant is off on sick leave and you are the most senior doctor in the
clinic.
You are about to see Jane White who is planning her first
pregnancy. Your task is to take a history and discuss the optimum management now
and during pregnancy.
The GP letter reads:
Prime Health Practice,
Primetown,
Sussex.
0298766543.
Practice Manager:
Mrs Willhelmina Bland.
Dear Doctor,
Please see Jane White, 35 years of age and planning her
first pregnancy. Her health is good – she seems only to attend the Practice for
routine checks such as cervical smears – the most recent of which was taken
last year and was normal. From talking to her and examining her records, it is
clear that she is very healthy and has always had good physical and mental
health. Her social circumstances are good. The one thing of concern is that she
told me she was on a diet in childhood supervised by the local paediatric team.
She can’t recall what it was about and she stopped the diet at about the age of
14. Both of her parents are dead – her mother fifteen years ago at the age of
40 and her father two years ago in a RTA, so cannot shed light on what the diet
was for. Fortunately, when I checked through her notes I came across
correspondence indicating that the problem was phenylketonuria. I have told her
that I am no expert in phenylketonuria and the implications for pregnancy, so
have eschewed the temptation to provide any advice.
I look forward to receiving your expert report.
Dr. John Worthy.
27. Structured
discussion. Write a protocol.
28. Risk Management.
Question 1.
Lead-in.
The following scenarios relate to risk management /
disciplinary procedures.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
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.
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call for help from the senior midwife
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go back to the labour ward and pretend that nothing has
happened
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go back to the labour ward and inform the senior midwife
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phone the GMC
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phone the on-call consultant anaesthetist
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phone the on-call consultant obstetrician
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phone the police
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put the anaesthetist in the recovery position and remove
the mask
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none of the above
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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.
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discuss the case with the Chief Executive
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discuss the case with the Medical Defence Union
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discuss the case with the BMA
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discuss the case with the Medical Director
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discuss the case with the most senior person in the
personnel department
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discuss the case with the Postgraduate Dean
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report the anaesthetic registrar to the GMC
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resign from being Clinical Director to avoid stress
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summon the anaesthetic registrar to give him a severe
telling-off
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