WEEKLY SJT PRACTICE QUESTIONS
Ranking Question 1
You are an FY1 on call. You are called to a cardiac arrest of a 60-year-old gentleman. You notice that his wife is present as the crash team performs CPR. She is very distressed but keen to stay.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A Take her into a quiet room, listen to her concerns and explain the situation
B Allow her to watch the CPR whilst explaining what the arrest team is doing
C Allow her to watch the CPR and ask a nurse to stay with her
D Ask her to leave as you feel it is too distressing for her to see
E Ask the medical SPR to explain the situation to her whilst you run the crash call
Answer: BCADE
Rationale
This question assesses your ability to respect the wishes of patient relatives whilst ensuring the patient receives the treatment they need. Resus council guidelines recommend that families be given the choice of whether to stay during the resuscitation. You are told that the wife is keen to stay for the resuscitation and therefore she should be allowed to. The best option is for you (B) or a nurse (C) to stay with her. (B) comes first as it includes an explanation of what the team is doing. The least appropriate option is for you to run the crash call instead of your medical registrar as you would be acting beyond your competencies as an FY1 (E). It is less appropriate to ask her to leave than to stay, however between the two, explaining the situation in a quiet room (A) is better than simply asking her to leave (D).
Ranking Question 2
You arrived on the ward this morning to discover that a phosphate infusion that you had prescribed last night before leaving has not been administered. You remember handing the prescription over to the nurse looking after the patient. She has now finished her shift.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A Set up the infusion yourself immediately.
B Check the patient's serum phosphate today as it may no longer be required.
C Inform the senior sister on the ward of the situation straight away.
D Call the nurse in from her day off to explain her actions.
E Prescribe oral phosphate supplementation whilst the IV form is sourced.
Answer: CAEBD
Rationale
This question assesses your ability to deal with medical errors, prioritise patient care and communicate with colleagues. The senior sister is likely to be able to organise for the infusion to be put up immediately (C) which immediately rectifies the problem. She will also be able to investigate, in due course, why the nurse did not carry out the request, in due course. You should prioritise patient care over asking the nurse who made the error for an explanation, making (D) inappropriate. Setting the infusion up yourself (A) allows the patient to receive the infusion however it is less good an option than going via the nursing sister as the nurse remains unaware of her error and therefore may make a similar mistake in the future. Oral phosphate (E) is not as effective as IV but is better than doing nothing (B) as if the serum phosphate level was low enough to warrant an infusion, it is unlikely that it will have normalised by itself.
Multiple Choice Question 1
As the F1 on a respiratory ward whilst checking bloods an angry relative storms towards you and starts shouting and swearing. She is the daughter of one of your patients. They are intimidating you and complain that the nursing staff have been administering their antibiotics late each day. They wish to make a formal complaint and are threatening to sue the hospital.
Choose the THREE most appropriate actions to take in this situation.
A. Advise them where the Patient Advice Liasion Service (PALS) office is located should they wish to make a formal complaint
B. Tell the nurses off and insist that they give the antibiotics on time from now on
C. Ban the relative from visiting this ward, it is not appropriate for them to shout at members of staff
D. Tell her that if she tries to sue she will be wasting her money
E. Ask the relative to speak with the nurse in charge instead, as giving medication is their responsibility
F. Inform the relative that her behaviour is aggressive and threatening and that this behaviour will not be tolerated
G. Tell the patient that their relative is behaving inappropriately
H. Try to answer any questions that the relative may have offering to try and address her concerns
Answer: A, F, H
Rationale
This question addresses your ability to deal with difficult relatives. Whether these concerns are founded or not they should be dealt with in the same manner – first of all, if this relative is being aggressive and intimidating then you need to ensure that you are safe (as well as your surrounding patients and colleagues). Informing the relative that this behaviour is unacceptable is important (F). The next step is to try and address their concerns and see what the issues are however if relatives or patients wish to complain they have a right to and should be directed to the third party which is the PALS office (A). Often a difficult situation can be resolved through good communication therefore assuming they calm down you should offer to address their concerns (H). It is less appropriate to pass an angry relative onto a team member like the nurse in charge (E), and definitely not your place to tell nurses off (B) or ban the relative from the ward (C). Commenting that to sue is a waste of money (D) and that they are being inappropriate (G) are less helpful and not as professional a way of dealing with the situation.
Multiple Choice Question 2
You have been trying to contact your clinical supervisor via email to meet to discuss your eportfolio personal learning objectives for the upcoming rotation. He eventually emails you saying he will fill it out on your behalf and that you don’t need to hold a meeting.
Choose the THREE most appropriate actions to take in this situation.
A. This is against the recommendations therefore it is your duty to express your concerns to the GMC as otherwise the training of juniors in the future could be jeopardised.
B. Allow your clinical supervisor to complete the portfolio without you but check in with him about your learning objectives to ensure they are ones you will be able to meet
C. Email him back with a list of objectives you have decided on and agree that it is much easier if he does it remotely
D. Email your clinical supervisor to express that you would much rather meet in person to go through the objectives, suggesting he recommend a convenient time to meet
E. Go and find your clinical supervisor to discuss the matter, making it clear that you will return at a different time if it is inconvenient at present
F. Express your dissatisfaction with the clinical supervisor, suggesting that if he doesn’t meet with you you will be forced to report him to the deanery
G. Discuss with your previous clinical supervisor, a rheumatologist that you got on very well with, and ask her advice
H. Express your concerns to your educational supervisor if you don’t manage to resolve the situation
Answer D, E, H
Rationale
This question assesses your ability to work with your senior colleagues and tests your communication skills. Doctors are often busy but all clinical supervisors should understand the importance of their role; they might simply require some reminding. Reminding them in person (E) or via email (D) of the importance of the learning objectives to shape your learning is appropriate. If this doesn’t work then the next step is to seek advice from your educational supervisor (H), who might be able to talk them directly and resolve the situation. This is just more appropriate than your previous clinical supervisor (G), which would be the 4th best option. You shouldn’t allow the learning objectives to be inputted without meeting (B), (C) as it does not allow you to discuss how you should achieve and measure these objectives. Threatening your supervisor (F) is a poor decision, and would reflect an inability to communicate with seniors. It is extreme to report this to the GMC (A)
Tip: beware of selecting an option because some parts of it appear appropriate eg preventing the training of other juniors being affected.
You are an FY1 on call. You are called to a cardiac arrest of a 60-year-old gentleman. You notice that his wife is present as the crash team performs CPR. She is very distressed but keen to stay.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A Take her into a quiet room, listen to her concerns and explain the situation
B Allow her to watch the CPR whilst explaining what the arrest team is doing
C Allow her to watch the CPR and ask a nurse to stay with her
D Ask her to leave as you feel it is too distressing for her to see
E Ask the medical SPR to explain the situation to her whilst you run the crash call
Answer: BCADE
Rationale
This question assesses your ability to respect the wishes of patient relatives whilst ensuring the patient receives the treatment they need. Resus council guidelines recommend that families be given the choice of whether to stay during the resuscitation. You are told that the wife is keen to stay for the resuscitation and therefore she should be allowed to. The best option is for you (B) or a nurse (C) to stay with her. (B) comes first as it includes an explanation of what the team is doing. The least appropriate option is for you to run the crash call instead of your medical registrar as you would be acting beyond your competencies as an FY1 (E). It is less appropriate to ask her to leave than to stay, however between the two, explaining the situation in a quiet room (A) is better than simply asking her to leave (D).
Ranking Question 2
You arrived on the ward this morning to discover that a phosphate infusion that you had prescribed last night before leaving has not been administered. You remember handing the prescription over to the nurse looking after the patient. She has now finished her shift.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A Set up the infusion yourself immediately.
B Check the patient's serum phosphate today as it may no longer be required.
C Inform the senior sister on the ward of the situation straight away.
D Call the nurse in from her day off to explain her actions.
E Prescribe oral phosphate supplementation whilst the IV form is sourced.
Answer: CAEBD
Rationale
This question assesses your ability to deal with medical errors, prioritise patient care and communicate with colleagues. The senior sister is likely to be able to organise for the infusion to be put up immediately (C) which immediately rectifies the problem. She will also be able to investigate, in due course, why the nurse did not carry out the request, in due course. You should prioritise patient care over asking the nurse who made the error for an explanation, making (D) inappropriate. Setting the infusion up yourself (A) allows the patient to receive the infusion however it is less good an option than going via the nursing sister as the nurse remains unaware of her error and therefore may make a similar mistake in the future. Oral phosphate (E) is not as effective as IV but is better than doing nothing (B) as if the serum phosphate level was low enough to warrant an infusion, it is unlikely that it will have normalised by itself.
Multiple Choice Question 1
As the F1 on a respiratory ward whilst checking bloods an angry relative storms towards you and starts shouting and swearing. She is the daughter of one of your patients. They are intimidating you and complain that the nursing staff have been administering their antibiotics late each day. They wish to make a formal complaint and are threatening to sue the hospital.
Choose the THREE most appropriate actions to take in this situation.
A. Advise them where the Patient Advice Liasion Service (PALS) office is located should they wish to make a formal complaint
B. Tell the nurses off and insist that they give the antibiotics on time from now on
C. Ban the relative from visiting this ward, it is not appropriate for them to shout at members of staff
D. Tell her that if she tries to sue she will be wasting her money
E. Ask the relative to speak with the nurse in charge instead, as giving medication is their responsibility
F. Inform the relative that her behaviour is aggressive and threatening and that this behaviour will not be tolerated
G. Tell the patient that their relative is behaving inappropriately
H. Try to answer any questions that the relative may have offering to try and address her concerns
Answer: A, F, H
Rationale
This question addresses your ability to deal with difficult relatives. Whether these concerns are founded or not they should be dealt with in the same manner – first of all, if this relative is being aggressive and intimidating then you need to ensure that you are safe (as well as your surrounding patients and colleagues). Informing the relative that this behaviour is unacceptable is important (F). The next step is to try and address their concerns and see what the issues are however if relatives or patients wish to complain they have a right to and should be directed to the third party which is the PALS office (A). Often a difficult situation can be resolved through good communication therefore assuming they calm down you should offer to address their concerns (H). It is less appropriate to pass an angry relative onto a team member like the nurse in charge (E), and definitely not your place to tell nurses off (B) or ban the relative from the ward (C). Commenting that to sue is a waste of money (D) and that they are being inappropriate (G) are less helpful and not as professional a way of dealing with the situation.
Multiple Choice Question 2
You have been trying to contact your clinical supervisor via email to meet to discuss your eportfolio personal learning objectives for the upcoming rotation. He eventually emails you saying he will fill it out on your behalf and that you don’t need to hold a meeting.
Choose the THREE most appropriate actions to take in this situation.
A. This is against the recommendations therefore it is your duty to express your concerns to the GMC as otherwise the training of juniors in the future could be jeopardised.
B. Allow your clinical supervisor to complete the portfolio without you but check in with him about your learning objectives to ensure they are ones you will be able to meet
C. Email him back with a list of objectives you have decided on and agree that it is much easier if he does it remotely
D. Email your clinical supervisor to express that you would much rather meet in person to go through the objectives, suggesting he recommend a convenient time to meet
E. Go and find your clinical supervisor to discuss the matter, making it clear that you will return at a different time if it is inconvenient at present
F. Express your dissatisfaction with the clinical supervisor, suggesting that if he doesn’t meet with you you will be forced to report him to the deanery
G. Discuss with your previous clinical supervisor, a rheumatologist that you got on very well with, and ask her advice
H. Express your concerns to your educational supervisor if you don’t manage to resolve the situation
Answer D, E, H
Rationale
This question assesses your ability to work with your senior colleagues and tests your communication skills. Doctors are often busy but all clinical supervisors should understand the importance of their role; they might simply require some reminding. Reminding them in person (E) or via email (D) of the importance of the learning objectives to shape your learning is appropriate. If this doesn’t work then the next step is to seek advice from your educational supervisor (H), who might be able to talk them directly and resolve the situation. This is just more appropriate than your previous clinical supervisor (G), which would be the 4th best option. You shouldn’t allow the learning objectives to be inputted without meeting (B), (C) as it does not allow you to discuss how you should achieve and measure these objectives. Threatening your supervisor (F) is a poor decision, and would reflect an inability to communicate with seniors. It is extreme to report this to the GMC (A)
Tip: beware of selecting an option because some parts of it appear appropriate eg preventing the training of other juniors being affected.