Weekly SJTs: 3rd November
Ranking Question
You are the medical FY1 on call for the evening. You are on your way to the handover meeting which started 10 minutes ago when you get called by a nurse to say that a patient has a heart rate of 150. The patient is otherwise well.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A Proceed immediately to review the patient as they might be very unwell; handover can wait.
B Ask the nurse for the rest of the observations and some clinical history to determine the severity of the situation. If not peri-arrest, discuss the patient with the registrar as soon as you get to handover.
C Ask the nurse to take a set of observations and an ECG, informing them that someone will be up to see the patient soon.
D Go to the meeting and handover the patient to the night team.
E Ask the nurse to give a stat dose of metoprolol a beta blocker to reduce the heart rate down to safe levels whilst you are in handover and then review the patient immediately after handover.
Answer BCDAE
Rationale
This question assesses your ability to prioritise tasks and put patient care first. It is important to go to the handover meeting so that you make the night team aware of any patients you are concerned about. However, this patient might be unwell. If the patient were peri-arrest your only option would be to call for senior help and attend to them immediately. As they are “otherwise well” it is best to ask the nurse for observations and some history to allow you to assess over the phone how unwell the patient is (B) and inform your senior with this information available to help them prioritise urgency. The worst option is to blindly prescribe a beta blocker without assessing the patient properly (E). The middle options are ranked by deciding which provide the most information to the team you are going to hand over to. An ECG (C) is more helpful than nothing (D) to the registrar you are handing over to, but both are better than not attending handover at all, as this would mean information about this and other patients would not be communicated to the night team.
Multiple Choice Question
During a ward round your consultant breaks the bad news of a cancer diagnosis to a patient. Whilst taking blood from the patient later that day they start to ask you numerous in-depth questions about the diagnosis, treatment options and prognosis; most of which you do not know the answer to.
Choose the THREE most appropriate actions to take in this situation.
A Inform the patient that you will express their concerns to a senior colleague who will come and speak with them
B Reassure the patient that they will be okay, and not to worry about things. Recommend they ask again on tomorrow’s ward round
C Try to avoid answering any questions at all and leave the room quickly as it is not appropriate for an F1 to provide this information
D Explain you will get a senior to speak to them and inform your consultant what the patient said prior to the ward round later on in the week
E Telephone the next of kin first, inform them of the diagnosis and prognosis so that they, the person closest to the patient, can give the answers in a way the patient will understand
F Answer their questions as best as you can, explaining that you are the junior in the team and omitting any statistics or specific details but asking your senior to speak with them later that day
G Inform the patient that you cannot answer their questions fully as you are not familiar with the details, but that you will ask someone senior to do so
H Give the patient some details that you remember your consultant giving to another patient with a similar diagnosis of cancer
Answer A, F, G
Rationale
This assesses your ability to recognise the limitations of your knowledge and your ability to communicate with patients in a difficult situation. This situation will occur as an F1 so you need to be confident with managing it. It states in the question that the information asked is beyond your limitations – it is important is to recognise this (G) and be open with the patient about this fact.
You should also recognise that this patient has been given an upsetting diagnosis and will need answers to their questions so your senior will need to speak with them (A),(F) soon. Waiting until later in the week is therefore not appropriate (D. As a doctor you should act with integrity and be honest. Providing incorrect information is not appropriate (B), (H), nor is avoiding the situation (C) as providing the correct information is part of your duty of care to that patient. Calling the next of kin first involves breaking patient confidentiality (E) which is inappropriate.
You are the medical FY1 on call for the evening. You are on your way to the handover meeting which started 10 minutes ago when you get called by a nurse to say that a patient has a heart rate of 150. The patient is otherwise well.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A Proceed immediately to review the patient as they might be very unwell; handover can wait.
B Ask the nurse for the rest of the observations and some clinical history to determine the severity of the situation. If not peri-arrest, discuss the patient with the registrar as soon as you get to handover.
C Ask the nurse to take a set of observations and an ECG, informing them that someone will be up to see the patient soon.
D Go to the meeting and handover the patient to the night team.
E Ask the nurse to give a stat dose of metoprolol a beta blocker to reduce the heart rate down to safe levels whilst you are in handover and then review the patient immediately after handover.
Answer BCDAE
Rationale
This question assesses your ability to prioritise tasks and put patient care first. It is important to go to the handover meeting so that you make the night team aware of any patients you are concerned about. However, this patient might be unwell. If the patient were peri-arrest your only option would be to call for senior help and attend to them immediately. As they are “otherwise well” it is best to ask the nurse for observations and some history to allow you to assess over the phone how unwell the patient is (B) and inform your senior with this information available to help them prioritise urgency. The worst option is to blindly prescribe a beta blocker without assessing the patient properly (E). The middle options are ranked by deciding which provide the most information to the team you are going to hand over to. An ECG (C) is more helpful than nothing (D) to the registrar you are handing over to, but both are better than not attending handover at all, as this would mean information about this and other patients would not be communicated to the night team.
Multiple Choice Question
During a ward round your consultant breaks the bad news of a cancer diagnosis to a patient. Whilst taking blood from the patient later that day they start to ask you numerous in-depth questions about the diagnosis, treatment options and prognosis; most of which you do not know the answer to.
Choose the THREE most appropriate actions to take in this situation.
A Inform the patient that you will express their concerns to a senior colleague who will come and speak with them
B Reassure the patient that they will be okay, and not to worry about things. Recommend they ask again on tomorrow’s ward round
C Try to avoid answering any questions at all and leave the room quickly as it is not appropriate for an F1 to provide this information
D Explain you will get a senior to speak to them and inform your consultant what the patient said prior to the ward round later on in the week
E Telephone the next of kin first, inform them of the diagnosis and prognosis so that they, the person closest to the patient, can give the answers in a way the patient will understand
F Answer their questions as best as you can, explaining that you are the junior in the team and omitting any statistics or specific details but asking your senior to speak with them later that day
G Inform the patient that you cannot answer their questions fully as you are not familiar with the details, but that you will ask someone senior to do so
H Give the patient some details that you remember your consultant giving to another patient with a similar diagnosis of cancer
Answer A, F, G
Rationale
This assesses your ability to recognise the limitations of your knowledge and your ability to communicate with patients in a difficult situation. This situation will occur as an F1 so you need to be confident with managing it. It states in the question that the information asked is beyond your limitations – it is important is to recognise this (G) and be open with the patient about this fact.
You should also recognise that this patient has been given an upsetting diagnosis and will need answers to their questions so your senior will need to speak with them (A),(F) soon. Waiting until later in the week is therefore not appropriate (D. As a doctor you should act with integrity and be honest. Providing incorrect information is not appropriate (B), (H), nor is avoiding the situation (C) as providing the correct information is part of your duty of care to that patient. Calling the next of kin first involves breaking patient confidentiality (E) which is inappropriate.