Example Ranking Question

You are just finishing a busy shift on the Acute Admissions Unit (AAU). Your FY1 colleague who is due to replace you for the evening shift leaves a message with the nurse in charge that she will be 15 to 30 minutes late. There is only a 30 minute overlap between your timetables to handover to your colleague. You need to leave on time as you have a social engagement to attend with your partner.

Rank in order the following actions in response to this situation (1= Most appropriate; 5= Least appropriate)

A. Make a list of the patients under your care on the AAU, detailing their outstanding issues, leaving this in the doctors' office when your shift ends and then leave at the end of your shift

B. Quickly go around each of the patients on the AAU, leaving an entry in the notes highlighting the major outstanding issues relating to each patient and then leave at the end of your shift

C. Make a list of patients and outstanding investigations to give to your colleague as soon as she arrives

D. Ask your specialty trainee* if you can leave a list of your patients and their outstanding issues with him to give to your colleague when she arrives and then leave at the end of your shift

E. Leave a message for your partner explaining that you will be 30 minutes late

Answer: ECDBA

Rationale: This question asks you to demonstrate your commitment to patient care. Although it is not appropriate for trainees to stay for an extensive period of time after their shift ends, or do this on a regular basis, staying an extra 30 minutes on this occasion is important to ensure an effective handover (E). It is more appropriate to provide information directly to your colleague to ensure they receive it (C) and your registrar/specialty trainee could also be able to ensure that your colleague receives the information (D). Leaving lists of information on the end of a bed is less effective and leaving a list in the general doctors' office is least effective as your colleague is unlikely to know it is there (B, A)..


Example Multiple Choice Question

You review a patient on the surgical ward who has had an appendicectomy done earlier on the day. You write a prescription for strong painkillers. The staff nurse challenges your decision and refuses to give the medication to the patient.

Choose the THREE most appropriate actions to take in this situation

A. Instruct the nurse to give the medication to the patient

B. Discuss with the nurse why she disagrees with the prescription

C. Ask a senior colleague for advice

D. Complete a clinical incident form

E. Cancel the prescription on the nurse's advice

F. Arrange to speak to the nurse later to discuss your working relationship

G. Write in the medical notes that the nurse has declined to give the medication

H. Review the case again

Answer: BCH

Rationale: 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 (B). Therefore it would also be important to review the patient again (H). 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 (C).