Weekly SJT practice questions
Ranking Question
You have just returned home from your day shift and suddenly realise that you have double dosed a patient's subcutaneous heparin, prescribing it twice a day instead of once a day.
A Phone the hospital ward, and speak to the nurse in charge ensuring that she checks the drug chart and asks the doctor on call to cross one of the doses off
B Cross the dose out in the morning before it is due to be given
C Phone the on call registrar to inform them of your mistake
D Phone the FY1 on call, explain your mistake and ask them to ensure one of the doses is crossed off
E Phone the on call consultant to apologise for your mistake
Answer: DACEB
This question assesses your ability to put the patient first and be safe. Double the dose of therapeutic heparin could significantly increase the patient's risk of bleeding. The best option is that which most reliably ensures that the second dose is crossed off. Phoning the FY1 on call (D) provides direct communication with the doctor who will be responsible for crossing it off. Speaking through an intermediary, the nurse on the ward (A), would probably solve the problem but is less direct and therefore second best. Speaking to the consultant and even registrar is over the top for this incident, putting (C) and (E) 3rd and 4th respectively. Leaving the problem until the morning (B) is the least appropriate option as it risks the dose being given early before you arrive.
Multiple Choice Question
You are the medical F1 on the cardiology firm. A patient you clerked with chest pain was due to have a 12 hour troponin sent at 8am so that the result was available for the ward round at 9am. It is now 9am and you suddenly realise you forgot to put the blood request form out, and as a result the patient has not had their blood test.
A. Wait for you consultant to ask, then check for the result, explaining that you can't understand why the test it not back yet
B. Quickly take the blood, and send it to the lab urgently, and explain the delay to the consultant on the ward round
C. Call the on call F1 and ask them to help you out by taking the blood
D. Explain the situation to your consultant and ask him if it’s ok for you to peel off to arrange the troponin urgently
E. Tell your team, and arrange for one of you to take blood for the patient whilst the rest see other patients on the ward
F. Don't worry about it as you can make a decision based on the ECG and clinical symptoms anyway
G. Carry on with the ward round to avoid a delay and sort the test out afterwards
H. Leave a blood request form out for the phlebotomist tomorrow
Answer: B, D, E
This question assesses your ability to deal with a mistake, putting the patient first and show integrity. You have made a mistake, which could affect the clinical decision, for instance, this patient might need further investigation like an angiogram, which could now be delayed. It is important to rectify this mistake and to be honest about the fact you have made it. (B) shows initiative in solving the problem before you have even asked about it subsequently explaining the mistake. In (D) and (E) you are honest and tell a senior your mistake and then rectify it to ensure patient care is put first. All three are appropriate.
(A) is dishonest, and will delay the test result, (C) is inappropriate as it is not an emergency situation and the patient's team are around and therefore this should not fall to the on call F1. (F) does not help the patient as a troponin will help in making the clinical decision, and (G) and (H) would result in unnecessary delay.
You have just returned home from your day shift and suddenly realise that you have double dosed a patient's subcutaneous heparin, prescribing it twice a day instead of once a day.
A Phone the hospital ward, and speak to the nurse in charge ensuring that she checks the drug chart and asks the doctor on call to cross one of the doses off
B Cross the dose out in the morning before it is due to be given
C Phone the on call registrar to inform them of your mistake
D Phone the FY1 on call, explain your mistake and ask them to ensure one of the doses is crossed off
E Phone the on call consultant to apologise for your mistake
Answer: DACEB
This question assesses your ability to put the patient first and be safe. Double the dose of therapeutic heparin could significantly increase the patient's risk of bleeding. The best option is that which most reliably ensures that the second dose is crossed off. Phoning the FY1 on call (D) provides direct communication with the doctor who will be responsible for crossing it off. Speaking through an intermediary, the nurse on the ward (A), would probably solve the problem but is less direct and therefore second best. Speaking to the consultant and even registrar is over the top for this incident, putting (C) and (E) 3rd and 4th respectively. Leaving the problem until the morning (B) is the least appropriate option as it risks the dose being given early before you arrive.
Multiple Choice Question
You are the medical F1 on the cardiology firm. A patient you clerked with chest pain was due to have a 12 hour troponin sent at 8am so that the result was available for the ward round at 9am. It is now 9am and you suddenly realise you forgot to put the blood request form out, and as a result the patient has not had their blood test.
A. Wait for you consultant to ask, then check for the result, explaining that you can't understand why the test it not back yet
B. Quickly take the blood, and send it to the lab urgently, and explain the delay to the consultant on the ward round
C. Call the on call F1 and ask them to help you out by taking the blood
D. Explain the situation to your consultant and ask him if it’s ok for you to peel off to arrange the troponin urgently
E. Tell your team, and arrange for one of you to take blood for the patient whilst the rest see other patients on the ward
F. Don't worry about it as you can make a decision based on the ECG and clinical symptoms anyway
G. Carry on with the ward round to avoid a delay and sort the test out afterwards
H. Leave a blood request form out for the phlebotomist tomorrow
Answer: B, D, E
This question assesses your ability to deal with a mistake, putting the patient first and show integrity. You have made a mistake, which could affect the clinical decision, for instance, this patient might need further investigation like an angiogram, which could now be delayed. It is important to rectify this mistake and to be honest about the fact you have made it. (B) shows initiative in solving the problem before you have even asked about it subsequently explaining the mistake. In (D) and (E) you are honest and tell a senior your mistake and then rectify it to ensure patient care is put first. All three are appropriate.
(A) is dishonest, and will delay the test result, (C) is inappropriate as it is not an emergency situation and the patient's team are around and therefore this should not fall to the on call F1. (F) does not help the patient as a troponin will help in making the clinical decision, and (G) and (H) would result in unnecessary delay.