SJT-Ranking Questions

You are at a famous bar in Dublin enjoying your Guinness after hectic hospital routine on Friday night and you hear a group of doctors and nurses from your hospital loudly joking about identifiable patients in their ward.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Challenge the whole group so that they are aware that their behavior is inappropriate.
D) Contact a manager in their department the following working day to alert them to this breach.
E) Ignore the situation and not cause a scene.
B) Call hospital security and ask them to intervene.
A) Speak to the person who is speaking the loudest, so they are aware that their behavior is inappropriate

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You are a nurse working in a hospital ward. A colleague of yours is refusing to care for a patient with HIV and is making derogatory comments about the patient’s lifestyle. What actions should you take?

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Discuss the situation with a colleague who is not involved in the situation to get their opinion.
D) Ignore the situation and continue with your own work.
A) Speak to the colleague directly and explain that their behavior is unprofessional and discriminatory.
B) Report the colleague to a senior nurse or manager on the ward.
C) Confront the colleague in front of other staff and patients to make them aware of their inappropriate behavior.

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You are a doctor walking through a ward and hear a nurse verbally abusing an elderly patient with severe dementia. The tone and language used are unpleasant.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Make preliminary enquiries from other staff working that night to ask if they have noticed inappropriate behaviour
D) Use body language to show your disapproval but do nothing formally as patient safety is not at risk.
B) Discuss the situation with a Clinical Nurse Manager (CNM) in the first instance as soon as they arrive
A) Confront the nurse and separate them from the patient.
E) Contact the police anonymously to avoid raising the issue with employees of your hospital.

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What is the appropriate action to take if you are asked to sign an agreement not to raise concerns with bodies outside of your employing organisation during induction at your new hospital ?

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Contact your medical defence organization or the IMC for advice if in doubt.
B) Throw the form away and hope that no one notices that it was not returned.
D) Sign the form but resolve to raise concerns about patient safety in whatever way is necessary to ensure their resolution.
A) Sign the form and begin work as instructed.
C) Explain that you cannot sign as this prohibits you from raising concerns about patient welfare.

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You are a newly qualified doctor starting your first job. You are asked to prescribe a medication for a patient by a registrar, but you notice that the dose is higher than the recommended safe dose. The registrar tells you that this is the dose that they usually prescribe for this patient, and they want to continue with it.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Ask another senior colleague for advice before deciding on what to prescribe.
B) Follow the registrar's instructions and prescribe the medication at the higher dose.
D) Prescribe the medication at the higher dose but document the conversation with the registrar and the reasons for prescribing the higher dose.
E) Ignore the situation and prescribe the medication at the lower dose that you believe is safe, without discussing the situation with the senior colleague.
A) Refuse to prescribe the medication at the dose requested and explain your concerns to the registrar.

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You are working in a busy emergency room and a patient with a history of chronic pain management presents with severe pain. The patient claims they lost their medication and is requesting a refill of their opioids. You are unsure of the legitimacy of their claim.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Prescribe the opioids without hesitation as the patient appears to be in genuine pain.
B) Request additional information from the patient's previous provider before deciding.
A) Refuse to prescribe the opioids and recommend alternative treatments for pain management.
C) Prescribe a lower dosage of opioids than what the patient is accustomed to.
E) Provide the patient with a prescription for a higher dosage of opioids than what they are accustomed to in case they are lying about the lost medication.

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You are working in a busy emergency room when a patient presents with severe chest pain and shortness of breath. The triage nurse has already ordered an electrocardiogram (ECG) and started the patient on oxygen therapy. As you review the ECG, you notice that the patient is having a heart attack. Which of the following actions would be most appropriate in this situation?

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Immediately activate the cardiac catheterization team to perform an emergency angiogram.
D) Administer aspirin to the patient to help prevent further clotting.
C). Consult with a cardiologist before initiating any treatment.
E) Perform further diagnostic tests before initiating any treatment.
B) Administer a thrombolytic agent to the patient to dissolve the clot causing the heart attack.

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You are a junior doctor who has been asked by a patient to keep a medical condition a secret from their family. The patient is worried about the impact that the disclosure may have on their family relationships. You are concerned about the patient’s safety and wellbeing, and you are also worried about the potential for harm to others if the condition is not disclosed.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Explain to the patient the potential harm of not disclosing the condition to their family, and the importance of informing the family.
D) Contact the patient's family and disclose the condition, without the patient's consent, if you believe that there is a serious risk of harm to the patient or others.
C) Seek advice from a senior clinician or the hospital's ethics committee.
E) Discuss the situation with your colleagues and try to persuade the patient to disclose the condition to their family.
B) Respect the patient's autonomy and maintain patient confidentiality, unless there is an immediate risk of harm to the patient or others.

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You are a doctor (NCHD) in a hospital with limited resources. You have two patients, one elderly man and one young woman, both in critical condition and in need of a ventilator. You only have one ventilator available. The hospital administration has instructed you to prioritise the younger patient due to the potential for a longer life expectancy. However, the older patient has a chance of survival with the ventilator too. You are struggling to decide what to do.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Try to find alternative options or resources to obtain another ventilator.
D) Provide the ventilator to the older patient, ignoring the hospital's instruction.
A) Consult with the hospital ethics committee or a senior medical staff member.
C) Provide the ventilator to the younger patient, following the hospital's instruction.
B) Speak with the hospital administration and explain your concerns.

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Your team is treating a patient who has been admitted with symptoms consistent with COVID-19. The patient tests positive for the virus and is immediately transferred to the isolation ward. You have been in close contact with the patient during the initial examination, and you are not vaccinated against COVID-19. You feel fine and show no symptoms, but you know that you should self-isolate for 10 days. However, you have MRCPI coming up, and missing it could jeopardise your career prospects.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Decide to take the exam and continue working as normal, since you do not have any symptoms.
A) Attend the exam and then self-isolate for the required time afterwards.
E) Attempt to conceal your situation and attend the exam as scheduled.
B) Inform your supervisor about your situation and request advice on whether to self-isolate or attend the exam.
C) Try to reschedule the exam and then self-isolate for the required time.

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You notice that a colleague is not performing clinical tasks appropriately and is not following correct procedures. You have raised your concerns with the colleague, but they have not changed their behaviour.

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

E) Speak to other colleagues about the situation and try to gather support for your concerns.
B) Report the colleague anonymously to the regulatory authority.
C) Confront the colleague in front of the team and demand an explanation.
D) Ignore the situation and continue working normally.
A) Speak to your supervisor or the clinical lead to raise your concerns.

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What should you do if your consultant suggests that you attend a one-day course in another city the following week, but you have no remaining annual leave days and are not entitled to study leave?

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Accept that you cannot attend the course this time and book the next one.
D) Add up the number of days that you worked late the week before and attend the course as you are owed enough hours in lieu.
B) Speak to your Educational Supervisor and, with their support, ask the service manager for special permission.
A) Ask your SHO if she will look after the ward in your absence and go if she agrees.
E) Attend the course as you already have your consultant’s permission.

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A teenage girl comes to you requesting contraception without their parents’ knowledge. They confide that they are sexually active and feel uncomfortable discussing this with their parents.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Contact her parents to inform them of their child's request for contraception and discuss the situation with them.
B) Discuss the importance of involving parents in her healthcare decisions and offer to speak with the parents together or separately.
E) Refuse to provide contraception without her parents' knowledge and advise them to abstain from sexual activity until they feel comfortable involving parents in her healthcare decisions.
C) Explain that as a minor, her parents have the legal right to be involved in their healthcare decisions and that you cannot provide contraception without their knowledge.
A) Respect her privacy and provide with information about contraception and safer sex practices.

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A patient with advanced dementia is admitted to the hospital with pneumonia. The family member who is the patient’s primary caregiver expresses concerns about the medical treatment the patient is receiving and believes the patient is not being adequately hydrated. They ask for your advice on what to do.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Explain to the family member the rationale for the medical treatment the patient is receiving.
A) Tell the family member not to worry and that the medical team is doing their best.
E) Agree with the family member that the medical team is not providing adequate care and suggest they take legal action against the hospital.
D) Suggest the family member file a formal complaint with the hospital.
B) Inform the medical team of the family member's concerns and ask them to address the hydration issue.

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You are working in a busy hospital emergency department and a patient arrives with a head injury. The patient is accompanied by a family member who is insisting that the patient be seen immediately and demanding that you skip other patients who have been waiting longer.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Assure the family member that the patient will be seen immediately and skip other patients who have been waiting longer.
E) Ignore the family member and attend to other patients who have been waiting longer.
A) Explain to the family member that the patient will be seen as soon as possible but that there are other patients with urgent needs who have been waiting longer.
D) Consult with a senior member of the medical team to determine the best course of action.
B) Politely ask the family member to wait in the waiting room and inform them that you will update them as soon as possible.

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A patient with a history of alcohol abuse has been admitted to the hospital for acute pancreatitis. The patient is in severe pain and is requesting strong pain medication, but you notice that their medical chart indicates a history of opioid addiction.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Prescribe the opioids as requested by the patient to manage their pain.
E) Disregard the patient's history of opioid addiction and prescribe the opioids as requested by the patient.
A) Discuss the patient's pain management options with the care team and consider alternative pain management strategies.
C) Consult with a pain management specialist to develop a safe and effective pain management plan for the patient.
B) Inform the patient of their history of opioid addiction and explain why prescribing opioids may be problematic.

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A patient with a history of congestive heart failure has been prescribed a medication known to exacerbate the condition. The prescription was mistakenly entered into the electronic health record by a trainee doctor who was not familiar with the patient’s medical history.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Alter the prescription to a lower dose and continue to monitor the patient for any adverse effects.
D) Document the incident in the patient's medical record and report it to the hospital's quality assurance department.
B) Check the patient's vital signs and assess whether they are experiencing any symptoms of heart failure.
C) Inform the nurse in charge of the patient to hold the medication until the prescribing doctor can be reached.
A) Contact the prescribing doctor immediately to inform them of the mistake and advise them to stop the prescription.

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What actions should you take if you discover that a registrar has prescribed Tazocin, which contains a penicillin antibiotic, for Tim, a young male patient who has had a previous anaphylactic reaction to penicillin?

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Speak with the registrar to alert him/her to the mistake.
A) Strike out the prescription and inform the nurse not to administer the medication.
D) Ensure that the patient's allergy is clearly documented on the drug chart and in their notes.
E) Amend the prescription without making a fuss.
B) Complete a clinical incident form.

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You are a medical student on a placement in a busy hospital. During your shift, you witness a consultant speaking harshly to a 1st year GP-Trainee in front of other staff members. You can see that the junior doctor is visibly upset.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Inform the junior doctor that you witnessed the incident and offer your support
D) Do nothing as it is not your place to intervene in an argument between colleagues
A) Approach the consultant and ask to speak with them privately
C) Speak to the consultant’s supervisor or manager about the incident
E) Report the incident anonymously to the hospital’s complaints department to avoid confrontation.

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You receive your first pay-check as a qualified doctor at the end of a busy month working in a hectic emergency department. You are surprised to find that you have received payment for additional night shifts, despite not having worked those specific shifts. You calculate that the additional payment you have received is significantly more than the extra hours you have had to work in the emergency department.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Discuss the issue with your Educational Supervisor, as you should not be working outside your contracted hours.
B) Donate 95% of the additional income to a charity of your choice, keeping a small amount as compensation for your efforts.
E) Alert payroll to the error so that any additional payment can be returned or adjusted from your salary.
C) Keep a work diary of the number of hours that you are working.
A) You believe you deserve the extra payment for the hard work you've done and decide to keep the money.

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One of your junior colleagues on the team regularly takes home a copy of the patients’ investigations as there is no confidential waste bin available on the ward. He argues that this helps him prepare for the following day’s consultant ward round by allowing them to memorise the patient details in advance.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Inquire with a Clinical Nurse Manager (CNM) about getting a confidential waste bin on the ward
C) Tell your colleague that it is unfair to know patient details before the ward round, and it makes you look disorganised.
A) Explain to your colleague that they should not be taking patients' investigations home every day.
D) Take a copy of the patients' investigations home to be as well-informed as your colleague.
B) Discuss your colleague's behavior with the consultant.

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During a two-week vacation in Australia, you become involved in a heated argument at a restaurant and subsequently receive a caution from the police. You return to work feeling upset and embarrassed, but determined to move on from the incident.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Try to put the issue behind you.
B) Wait until you have settled into your new rotation before raising the issue.
C) Inform your Medical Defence Organisation and seek legal advice.
D) Contact the IMC (Irish Medical Council) immediately to report the caution.
E) Ask your consultant for advice on how you should proceed.

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During a two-week vacation in Spain, you become involved in a heated argument at a restaurant and are subsequently given a caution by the local police. You return to work feeling upset and embarrassed but determined to put the entire incident behind you.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Inform your Medical Defence Union and seek legal counsel.
A) Attempt to move past the issue.
D) Contact the IMC (Irish Medical Council) immediately to report the caution.
B) Wait until you have settled into your new rotation before addressing the matter.
E) Consult your supervising consultant for advice on how to proceed.

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You arrive at work before the consultant ward round and attempt to prepare the patient list. You are hindered by a slow computer and a malfunctioning printer. The ward round cannot begin until you have an updated patient list, and your consultant is growing impatient as they need to start an all-day surgery list.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Ask a medical student to prepare the list while you begin the ward round.
B) Send the patient list to your personal email address and print it on a nearby ward.
D) Inquire with the nurses on each of the wards if there are any new patients under your consultant's care.
E) Suggest the team reconvene in 15 minutes while you contact the IT helpdesk and attempt to prepare the list.
A) Voice your frustration with the IT equipment and insist that the consultant requests replacements.

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While on your break, you witness a 1st year GP-Trainee colleague arguing with a pharmacist in front of a patient. Later, the pharmacist approaches you to discuss the doctor’s behavior. They mention that the doctor has had several confrontational incidents since joining the ward two months ago and is unsure how to handle the situation.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Suggest the pharmacist speak with their line manager as it is not your responsibility to get involved in pharmacy-related matters.
E) Send an email to your trainee colleague detailing what the pharmacist has told you, to provide a written record of your conversation.
B) Contact the trainee and ask them to return to the ward and apologize to the pharmacist and patient.
C) Apologize on behalf of the trainee, and ask the pharmacist not to pursue the matter any further at this time as you will speak to the other doctor.
D) Inform the trainee colleague's Clinical Supervisor about the incident and what the pharmacist has told you.

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You notice a fellow intern berating a healthcare assistant in front of a patient. Afterward, the healthcare assistant approaches you to discuss the intern’s behavior. They explain that the intern has had several ‘angry outbursts’ since joining the ward two months ago, and they are unsure how to address the situation.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Call the intern and ask them to return to the ward and apologize to the healthcare assistant and patient.
E) Send an email to your intern colleague detailing what the healthcare assistant has told you, to provide a written record of your conversation.
C) Apologize on behalf of the intern and ask the healthcare assistant not to pursue the matter any further at this time, as you will speak to the other doctor.
A) Advise the healthcare assistant to speak with their line manager, as it is not your responsibility to get involved in matters unrelated to your role.
D) Inform the intern's Educational Supervisor about the incident and what the healthcare assistant has told you.

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During a bus journey back from a conference in Dublin, an announcement is made requesting medical assistance for one of the passengers. You graduated from medical school three weeks ago and have yet to start your first job as an intern; you feel particularly apprehensive about attending to a possible on-bus emergency on your own.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Do nothing since you are not legally bound to provide medical assistance as you have not yet signed a contract with your employer.
A) Wait for ten minutes to see if anyone else on board can assist before volunteering to assess the passenger.
E) Review the passenger, but ask the bus staff to make an announcement for more senior medical assistance as you are only recently qualified and very inexperienced.
D) Approach the unwell passenger and determine if you will be able to offer any help before informing the bus staff of your presence.
C) Inform the bus staff that you are a recently qualified doctor, and begin your medical assessment immediately.

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During a train journey back from a weekend in Galway, an announcement is made requesting medical assistance for one of the passengers. You graduated from medical school three weeks ago and have yet to start your first job as an intern; you feel particularly apprehensive about attending to a possible on-train emergency on your own.

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

B) Inform the train staff that you are a recently qualified doctor, and begin your medical assessment immediately.
D) Wait for ten minutes to see if anyone else on board can assist before volunteering to assess the passenger.
E) Review the passenger, but ask the train staff to make an announcement for more senior medical assistance as you are only recently qualified and very inexperienced.
C) Approach the unwell passenger and determine if you will be able to offer any help before informing the train staff of your presence.
A) Do nothing since you are not legally bound to provide medical assistance as you have not yet signed a contract with your employer.

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During a lunch break, a group of medical students ask if you can help them prepare for their upcoming end-of-module examination on the cardiovascular system. You agree to teach them at the end of the week, provided that they assist you with some administrative tasks that evening, which they agree to do. You are reminded about your teaching commitment the day before the students’ examination, but unfortunately, you have forgotten to prepare a relevant lesson plan.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Postpone the teaching until they want to prepare for their next end-of-module examination.
D) Utilize a teaching style that focuses on questioning the students and reflecting every question asked back towards the group.
B) Inform the students that they should have reminded you earlier in the week, and now you are unable to teach them.
E) Attempt to teach the students, even if your knowledge is insufficient, but finish the teaching early if it does not prove helpful.
A) Teach the students about gastroenterology, with which you are more comfortable.

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During a lunch break, a group of medical students ask if you can help them prepare for their upcoming end-of-module examination on the renal system. You agree to teach them at the end of the week, provided that they assist you with some paperwork tasks that evening, which they agree to do. You are reminded about your teaching commitment the day before the students’ examination, but unfortunately, you have forgotten to prepare a relevant lesson plan.

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

D) Utilize a teaching style that focuses on questioning the students and reflecting every question asked back towards the group.
C) Postpone the teaching until they want to prepare for their next end-of-module examination.
E) Attempt to teach the students, even if your knowledge is insufficient, but finish the teaching early if it does not prove helpful.
B) Inform the students that they should have reminded you earlier in the week, and now you are unable to teach them.
A) Teach the students about immunology, with which you are more comfortable.

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A final-year medical student on your ward asks you to write a reference in support of their application for a part-time photography course, which starts two months before their final-year examinations. You are concerned because, despite their enthusiasm, the student has a poor clinical knowledge base. You are not convinced by their assurances that they will be able to balance this new commitment with their medical course.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Set the student a mock clinical examination and offer to write their reference based on their performance.
C) Suggest that they ask your consultant to write a reference to provide a more experienced perspective on their ability.
E) Tell the student that your position might not qualify you to comment on their suitability for the course.
B) Write a reference indicating that their clinical knowledge base is poor but that they might do much better in a different subject.
A) Write a supportive reference, as their clinical knowledge base is not relevant to their performance in a photography course.

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A female SHO colleague in cardiology is clerking a nervous 16-year-old boy who has been brought into A&E by his mother, claiming that he has been experiencing chest pain after being assaulted. After establishing a good rapport with the patient, the SHO arranges for a physical examination. However, the boy remains adamant that no one else be present. In the absence of your registrar, your fellow SHO asks for your advice.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Suggest that she performs a physical examination by inspection alone, with a chaperone present if the boy agrees.
A) She should agree to forego the chaperone and complete a thorough physical and internal examination to rule out any injury.
E) Tell her to insist on the presence of a male nurse as a chaperone and to avoid examining the patient if he insists on no one else being present.
D) Ask the boy's mother to sign in the medical notes agreeing to act as the chaperone.
B) Advise her not to examine the patient and instead wait for the registrar.

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Your hospital has recently been in the headlines due to a confidential report revealing an increase in postoperative complications following laparoscopic surgeries. As a junior doctor in the general surgery department, you strongly believe that the media’s portrayal of your senior colleagues is unjust, attributing the complication rates to the recent transition to a new type of surgical equipment. As you are leaving the hospital, a reporter approaches you for a comment on the situation.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Express your irritation about the lack of understanding shown by the media and the general public regarding the intricacies of healthcare and medical practice.
C) Respectfully decline to provide a comment.
B) Obtain the reporter's contact information and agree to an interview once you've obtained approval from your hospital's administration.
A) Discuss openly with the reporter your views on the competence of your senior colleagues and the possibility of the new surgical equipment being at fault.
D) In broad terms, talk about the hurdles faced by medical practitioners when new surgical techniques or equipment are introduced, without referring specifically to your department.

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39.As a junior doctor in neurology, you are responsible for looking after your consultant’s patients. One of the patients who had been under your care for the last 48 hours is transferred to the premium care unit on the other side of the hospital. At the request of your consultant, the nurses in the premium care unit have paged you on several occasions to perform various clinical procedures. You feel overwhelmed by the extra workload and are unsure whether you will be able to complete your regular tasks.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Share your concerns with one of the other neurology consultants.
E) Schedule a meeting with the neurology consultant, via their secretary, to discuss the increased workload.
B) Ask the consultant for additional compensation in return for spending more time assisting with their premium care patients.
D) Speak to the patient and ask whether they would mind returning to the standard ward.
A) Ignore any pages from the premium care unit; if the consultant really needs you, they will contact you directly.

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You are an intern with a strong interest in cardiology. To enhance your application for a specialty training program, you desire to complete an Advanced Cardiac Life Support (ACLS) course. However, your hospital gives priority to doctors working in Intensive Care Units (ICU). One of the ICU doctors, who secured a spot based on their current role, offers you the course spot in exchange for covering one of their on-call shifts.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Agree to the arrangement, as it seems to be mutually beneficial.
E) Seek counsel from the ACLS coordinator at your hospital.
B) Inform the ICU doctor that you appreciate the offer but are unwilling to cover the on-call shift.
A) Reject the proposal outright.
D) Accept the offer and participate in the course, but fail to show up for the on-call shift.

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As a junior doctor in the paediatrics department, you are tasked with administering vaccinations to several patients. A fellow doctor who works alongside you is asked to vaccinate a patient they’ve been taking care of. However, the doctor has a conscientious objection to vaccinations, based on personal beliefs, and would prefer if you could administer the vaccine even though you have not personally treated the patient.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Suggest to your colleague that they claim to lack the necessary training to administer vaccines.
E) Refuse to administer the vaccine on the grounds that you are not familiar with the patient.
C) Remind your colleague that they have a duty to put aside any personal beliefs and administer the vaccine.
A) Consent to administer the vaccination as your colleague has provided a valid reason for refusing.
D) Propose that they take a few days of annual leave, which will provide time for the department to find someone else to administer the vaccine.

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As a BST-Trainee doctor with an interest in paediatrics, you wish to improve your higher specialty training (HST) application by completing a Pediatric Advanced Life Support (PALS) course. Regrettably, your hospital gives precedence to doctors working in the Neonatal Intensive Care Unit (NICU). A NICU doctor, who has been allotted a place based on this policy, offers it to you if you agree to cover one of her night shifts.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Accept her offer as it seems to be an agreement that benefits both parties.
C) Decline the offer.
B) Inform the other foundation doctor that you are grateful for her offer, but you are unwilling to cover the night shift.
D) Consult with the PALS coordinator at your hospital for guidance.
E) Accept her offer and attend the course, but fail to show up for the night shift.

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You are a BST-Medicine trainee with an interest in gastroenterology. In an effort to enhance your specialty training application, you are keen on completing an Endoscopy Training Course. However, your hospital allocates priority for this course to doctors working in the surgical department. One of the surgical doctors, who has secured a place due to this arrangement, offers you his spot in exchange for you covering a few of his on-call duties.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Agree to his proposal and attend the course, but don't fulfill your promise to cover his on-call duties.
C) Decline the offer outright.
D) Consult with the coordinator of the Endoscopy Training Course at your hospital.
A) Accept the offer as it could potentially benefit both of you.
B) Inform the surgical doctor that you gratefully accept his offer but you are not prepared to cover his on-call duties.

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As the junior doctor in neurology, you are responsible for looking after your consultant’s public patients. One of the patients who had been under your care for the last 48 hours is transferred to a private clinic outside of the hospital. At the request of your consultant, the nurses at the private clinic have paged you several times to complete various clinical procedures. You find the additional workload challenging and are uncertain whether you will be able to complete your routine tasks.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Schedule a meeting with the neurology consultant, via his secretary, to discuss the additional workload.
E) Ignore any pages from the private clinic; if it's truly a request from the consultant, he will reach out directly to you.
B) Discuss the situation with one of the other neurology consultants.
A) Seek additional compensation from the consultant in exchange for your extra time assisting with his private patients.
C) Converse with the patient and ask if they would consider returning to the public ward.

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You are a new SHO-1 doctor on a gastroenterology team. The morning ward round is running late, and both your consultant and registrar need to attend a critical procedure. One patient has yet to be consented for an endoscopic retrograde cholangiopancreatography (ERCP) following the diagnosis of a common bile duct stone. Your registrar tells you to make sure that the patient is consented in time to be second on the morning list.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Ask an SHO from another team who can perform ERCPs to take consent.
C) Explain that you do not have sufficient experience to consent patients for this procedure.
E) Agree to consent the patient and then ask experienced nurses to show you how to do this correctly.
A) Consent the patient before addressing any other tasks.
B) Complete all urgent tasks arising from the ward round, and then consent the patient.

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As a newly minted SHO-1 in the gastroenterology department, you find yourself in the middle of a hectic morning ward round. Both your consultant and the senior registrar need to leave for a scheduled endoscopy list. There’s one patient who hasn’t yet given his consent for a colonoscopy after presenting with alarming GI symptoms. Your senior registrar instructs you to make sure the patient’s consent is obtained in time to be included on the morning list.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Express that you don't feel adequately trained to take consent for this procedure.
A) Consent the patient immediately, putting off other tasks.
B) Address all pressing tasks resulting from the ward round first, and then consent the patient.
E) Agree to consent the patient and then seek guidance from experienced nurses on how to correctly do this.
D) Ask an SHO-1 from another team, who routinely performs colonoscopies, to take the patient's consent.

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You are the SHO-1 doctor on call for general surgery. After examining a patient with appendicitis, you realize the need to insert a central venous line (CVL). Unfortunately, your only hands-on experience of this procedure was during a skills lab session two years ago. You’ve never attempted to perform a CVL insertion on a patient before and are feeling unsure about your success.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Try the procedure but without informing the patient about your lack of experience.
E) Attempt the procedure twice after discussing it with the patient, and then seek help if unsuccessful.
A) Contact the on-call surgical registrar and ask them to supervise your first CVL insertion.
D) Wait until your shift ends and then hand the task over to the night team.
B) Ask another SHO-1 doctor who is more experienced and comfortable with procedures to assist you.

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You are an SHO-1 doctor on call for neurology. After examining a patient with a severe headache, you realize the need for a lumbar puncture (LP). Unfortunately, your only experience of this procedure was on a simulator three years ago during medical school. You have never attempted to perform an LP on a patient before and are feeling unsure about your ability.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Request assistance from another SHO-1 who is present and more comfortable with the procedure.
C) Undertake the procedure, but without informing the patient about your lack of experience.
E) Make an attempt at the procedure after discussing it with the patient, and then seek help if unsuccessful.
A) Contact the on-call neurology consultant and request supervision for your first LP.
D) Delay until the end of your shift and then pass the task to the incoming on-call team.

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As a doctor in a hospital, you are asked by a senior consultant to prescribe a medication to a patient that you believe to be unnecessary and potentially harmful. The consultant is insistent that you write the prescription, and you are aware that they hold significant power within the hospital.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Consult with another senior consultant or hospital administrator about the situation and how to proceed.
E) Contact a medical ethics advisor or professional body for guidance on how to handle the situation.
C) Raise your concerns with the consultant, explaining your position and reasons for not wanting to prescribe the medication.
B) Refuse to prescribe the medication, citing your concerns about its necessity and potential harm.
A) Prescribe the medication as requested, to avoid potential repercussions.

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As an SHO-1 doctor on call, you are notified by the biochemistry lab about a critical lab result. The value they give you indicates severe hypokalaemia. You do not remember much about the management of hypokalaemia and have never managed a patient with this condition before.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Evaluate the patient to ensure their stability, and then call the on-call medical consultant.
E) Prescribe a beta blocker such as propranolol.
A) Contact the on-call medical consultant and ask for advice.
C) Use a search engine like Google to look up 'hypokalaemia' for guidance.
D) Refer to hospital protocols, either online or in hard copy.

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As an SHO-1 doctor on call, you receive a call from the laboratory about an abnormally high potassium level in a patient’s blood results, indicating severe hyperkalaemia. Your memory on the management of hyperkalaemia is a bit foggy and you have never managed a patient with this condition before.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Look up hospital guidelines or protocols, either in hard copy or online.
A) Contact the on-call medical consultant and ask for advice.
E) Prescribe a beta-blocker like atenolol.
C) Search for 'hyperkalaemia' on the internet to refresh your memory.
B) Immediately go to assess the patient's wellbeing, then call the on-call medical consultant.

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You’re an SHO-1 on a busy internal medicine round. Your consultant instructs you to order an urgent MRI scan and make sure it’s performed that afternoon. Although you take note of this on your tasks list, you’re uncertain about the justification for the scan.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Ask a colleague in your team to explain why the MRI scan is necessary.
B) Inform the duty radiologist that you question the necessity of the scan but were instructed that it's urgent.
E) Schedule a CT scan instead, and then reconsider the MRI scan later based on its findings.
C) Explain to your consultant that you're unable to order the scan as you're unsure of its appropriateness.
A) Ask the consultant why the scan is required.

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As an SHO-1 doctor on a hectic medical ward round, your consultant instructs you to request an urgent MRI scan to be completed that day. Despite jotting this down on your task list, you’re uncertain about the necessity of this scan.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Inform the duty radiologist that you're unsure about the need for the scan but have been ordered to request it.
D) Seek a fellow team member's explanation as to why the MRI scan is required.
E) Schedule a CT scan instead, and then reevaluate the necessity of the MRI scan based on its results.
C) Share your reservations with the consultant and express your discomfort in ordering the scan.
A) Inquire with the consultant about the purpose of the scan.

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As an SHO-1 doctor, your Ward Sister brings up an issue about a medication you prescribed erroneously. You prescribed a dose ten times higher than recommended, which was fortunately noticed by an alert pharmacist and never administered. However, a clinical incident report has been filed, and the Ward Sister plans to inform your Clinical Supervisor. You believe your fatigue contributed to this mistake.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Use your e-portfolio to document the mistake and reflect on its causes to prevent it from recurring.
A) Tell the Ward Sister that it wasn't your fault because the hospital forced you to work exhausting shifts.
B) Own up to the mistake but clarify the factors that may have led to the error.
E) Request a meeting with your Clinical Supervisor to discuss the error and your concerns about the shift rotation.
C) Request the Ward Sister not to contact your Clinical Supervisor as it was a one-off mistake.

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You are at a family gathering when you recall that you ordered a blood test for a patient in a critical condition, but you forgot to check the result or delegate the task before leaving.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Make a mental note to check the result first thing when your shift starts again.
C) Ignore the issue for now, emphasizing the importance of work-life balance.
E) Drive back to the hospital immediately to check the result yourself.
D) Reflect on this oversight and plan to devise a system to prevent such a lapse in the future.
B) Contact the on-call SHO-1 doctor and request them to check the result.

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You are enjoying a day off and have gone hiking. During the hike, you recall ordering a crucial lab test for a patient showing worrying symptoms, but you forgot to follow up or hand over this task.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Make a mental note to check the test result first thing on your next shift.
D) Reflect on this oversight and commit to establishing a system to avoid such errors in the future.
E) Drive back to the hospital to check the result yourself.
C) Try to forget about it—after all, everyone needs downtime.
B) Call the on-duty SHO doctor through the hospital switchboard and ask them to check the result.

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As a junior doctor, you’ve been told by a close colleague that you seem constantly irritated and have been for the past several weeks. While you acknowledge that you’re not your usual self, you attribute it to the high-stress environment and lack of rest. However, the suggestion from your colleague that you might be dealing with burnout has left you feeling uncomfortable.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Make an appointment with your GP for a check-up.
E) Use a burnout self-assessment tool online to evaluate your current state.
A) Engage in a discussion with your colleague to understand their observation and concern.
D) Ask other colleagues if they've observed similar changes in your behavior.
B) Schedule an appointment with your Occupational Health department to talk about your mental wellbeing.

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You are the junior doctor on call for surgery. A nursing colleague points out that you seem unusually ‘stressed’ and have been for a few weeks. You acknowledge you’ve been feeling more overwhelmed than usual but attribute it to the work pressure and fatigue. You are embarrassed by your colleague’s observation and do not believe you are suffering from burnout.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Schedule an appointment with your Educational Supervisor to discuss your emotional wellbeing.
A) Discuss with your colleague about the specifics of their concerns.
E) Use a burnout self-assessment tool to ascertain whether you require professional help.
C) Arrange a routine consultation with your GP.
D) Ask other surgical colleagues whether they think you're experiencing burnout.

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After a major cardiac procedure, a patient ends up with an implantable cardioverter defibrillator (ICD). You are the first doctor to see the patient once they regain consciousness, and they ask whether the ICD is a temporary solution. You are certain that ICDs are generally permanent, but you don’t remember much else about it.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Explain that ICDs are typically permanent, but you will help to find out the specific plan in their case.
E) Set aside time to study about ICDs so you can answer questions more thoroughly next time.
D) Offer to ask your registrar to visit later to answer specific questions.
A) Tell the patient that the ICD will be there for life.
B) Explain that you are a junior doctor and don't have the expertise to answer complex cardiac queries.

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You are a medical student on a surgical rotation. One of the surgical SHO makes a derogatory comment about a patient who is currently on the operating table under anaesthesia. The comment is offensive and discriminatory.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Confront the surgical SHO in front of other staff and let them know that their comment was offensive.
B) Speak to the attending surgeon in private and let them know what you overheard.
D) Ignore the situation and focus on the surgery.
A) Speak to the surgical SHO privately and let them know that their comment was inappropriate.
E) Report the surgical SHO to the hospital administration immediately.

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During a ward round, a patient recovering from a cholecystectomy asks you whether he’ll have to modify his diet permanently after the surgery. You remember that diet adjustments might be necessary but aren’t entirely sure about the specifics.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Allocate some time to research about diet post-cholecystectomy so you can respond to similar queries more effectively in the future.
B) Let the patient know that as a junior doctor, you're not equipped to provide detailed dietary advice.
A) Inform the patient that he will need to modify his diet.
D) Propose to ask your registrar to speak with the patient later for more precise advice.
C) Clarify that diet changes may be necessary post-cholecystectomy and that you'll seek more specific information for his case.

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During a late-night shift, you are monitoring a patient who has had a severe asthma attack. Despite administering nebulisers and corticosteroids, the patient’s oxygen levels continue to fall, and they are increasingly struggling to breathe. Even though you are a junior doctor, you’ve recently completed an Advanced Life Support (ALS) course and are confident in your ability to manage acutely unwell patients.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Continue caring for the patient, unless their condition deteriorates further.
C) Reach out to the consultant directly via mobile phone.
B) Persist in managing the patient, irrespective of their worsening condition.
D) Call the on-call registrar for advice.
A) Alert the Critical Care team.

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You are examining a critically ill patient in the emergency department. She is complaining of severe abdominal pain and shows signs of hypotension, even after fluid therapy. Over the past few minutes, her mental status has started to deteriorate. Although you are an junior doctor, you’ve recently undergone training in Advanced Trauma Life Support (ATLS) and feel capable of managing critically ill patients.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Contact the emergency department consultant directly.
E) Continue treatment unless her condition further deteriorates.
A) Activate the trauma team.
D) Reach out to the senior house officer (SHO) for advice.
B) Continue to provide care for the patient regardless of her clinical deterioration.

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You are called into your supervisor’s office, who expresses concerns about your performance. Specifically, they mention your occasional tardiness for ward rounds and that your clinical knowledge is not at the level they expect for a doctor at your stage. You disagree with this assessment, as you have only been late a few times, and you believe your clinical knowledge is up to standard.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Seek advice from your medical training program about the possibility of switching supervisors due to the perceived communication gap.
A) Discuss your perspective with the supervisor and request for specific examples to justify their concerns.
D) Conduct a peer-review assessment using your e-portfolio to gather feedback about your performance from other colleagues.
C) Ask your supervisor for guidance on how you can address their concerns and improve your performance.
E) Tell your supervisor that you consider your knowledge to be on par with other doctors at your level and that you were a high-achieving student in medical school.

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You are called into the office by your clinical supervisor. She expresses concerns about your performance, specifically mentioning your occasional tardiness for rounds and your level of clinical knowledge, which she finds unsatisfactory for a doctor at your stage. However, you disagree with her assessment as you recall being late only a couple of times and you feel confident about your knowledge base.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Point out to the supervisor that you believe your knowledge is comparable to that of your peers and mention your academic achievements in medical school.
C) Seek advice from the supervisor on how to address her concerns and improve your performance.
B) Inquire with the training program about the possibility of changing supervisor due to a perceived breakdown in communication.
A) Express your perspective respectfully, and ask her to provide concrete examples of her concerns.
D) Through your training portfolio, conduct a peer assessment survey seeking feedback about your performance from other trainees.

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As the on-call first-year GP-Trainee, your shift is supposed to end at 9 p.m., and then you should hand over to the incoming night doctor. However, one particular night doctor consistently refuses to take on tasks that they believe should have been finished during your shift. As a result, you often find yourself leaving at midnight whenever this doctor is on the night shift.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Document that the night doctor refused to accept a handover and then go home.
A) Report the night doctor to the IMC.
B) Discuss the issue with a relevant authority (e.g., Training Supervisor) as a priority the next day.
E) Tell the night doctor that you have completed as many tasks as you could, and they should assume responsibility for the remaining tasks at the end of your shift.
D) Stay late if necessary to ensure that patient safety is not compromised.

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As a surgical SHO, you are expected to prepare ahead for the morning ward round at 7:30 a.m. However, your Clinical Supervisor insists that you also attend the 8 p.m. evening ward round. These hours contradict your contractual work hours, which are from 9 a.m. to 5 p.m.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Sneak home for a few hours every day to comply with the Working Time Directive.
E) Tell your supervisor that you are contracted to work from 9 a.m. to 5 p.m.
C) Seek advice from your Educational Supervisor.
B) Disregard your supervisor's directions and work from 9 a.m. to 5 p.m., as your contract dictates.
A) Acknowledge that long work hours are part and parcel of any surgical role.

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As a trainee doctor, your registrar asks you to perform a lumbar puncture on a patient. You’ve never done this procedure before, but your registrar insists it’s easy and no one else can help until the evening ward round, seven hours away.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Politely explain you can't safely perform the procedure and need supervision.
E) Study the procedure before attempting it.
B) Proceed but make sure to document you were following your registrar's instructions.
D) Refuse to help because you're swamped with other ward duties.
A) Seek assistance from another doctor who has relevant experience.

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An elderly patient with severe heart failure is not improving despite optimal medical treatment. As the on-call cardiology SHO, you consider discussing the option of heart transplantation with the consultant cardiologist. However, the nursing staff and the patient’s family are convinced that the patient’s quality of life would not improve significantly and are advocating for comfort care measures only. You feel alone in your aggressive treatment approach.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Thoroughly familiarize yourself with the case and try to understand why the family and nursing staff want to opt for comfort care only.
D) Tell the patient's family to carefully consider the options and that you will respect their wishes if they all agree.
B) Stop all active treatment to ease the patient's suffering and hasten his death.
C) Contact a senior doctor to discuss the situation and ask for their opinion.
A) Ignore others and stick to your plan.

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A ward nurse contacts you while you’re on call about a unit of platelets that was accidentally removed from the fridge. As it cannot be put back, she requests you to prescribe it to a patient to avoid waste. You won’t be visiting the ward for a while and the nurse is anxious as the platelets will be unusable 30 minutes after refrigeration.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Mention clearly that transfusion should not be performed just to prevent waste
C) Drive to the ward as soon as possible to prescribe the platelets.
E) Suggest that she put the bag back into the refrigerator so it can be used by other patients.
D) Clarify that transfusion is associated with substantial risks and that there's no need to transfuse a non-thrombocytopenic patient.
B) Scold her for unnecessarily removing the bag and plan to fill out a clinical incident report after your shift.

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A nurse from a busy ward approaches you, a junior doctor, to sign off on a dosage of morphine she administered an hour ago to a patient in significant pain. Due to the high level of activity in the ward, she took this action and now insists this kind of practice is typical because of staffing issues.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Tell both nurses that only doctors have the required training to decide which drugs to prescribe.
A) Advise that a note should be made on the prescription chart and hospital notes to indicate the drug was administered.
D) Sign the prescription retrospectively.
C) Explain that an authorized prescriber must agree before drugs are given in the future.
B) Check the drug details to ensure that there were no contraindications and that an appropriate dose was administered.

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You are SHO, and during your night shift, you’re called to the room of a patient who is exhibiting symptoms of a severe allergic reaction. Despite several senior doctors being present, nobody seems to have administered adrenaline, a first-line treatment.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Prepare and administer adrenaline as per the protocol.
B) Ask the senior doctor why adrenaline hasn't been administered yet.
E) Ask if an allergist or immunologist is present or en-route.
D) Stay quiet, assuming the seniors are making the right decisions.
A) Assist with the patient's other symptoms that you're more comfortable managing.

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You are a doctor on call and receive numerous requests from different parts of the hospital at the same time. You need to decide which one to attend to first, and in what order of priority.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C A 30-year-old woman post gynecological surgery who needs discharge summary and prescription before leaving.
D) A 50-year-old man with chronic kidney disease experiencing a flare-up of pain and needing analgesic review.
B) A 75-year-old man with chronic obstructive pulmonary disease who suddenly develops difficulty breathing and becomes cyanotic.
A) An upset son who is dissatisfied with his father's care and wants to discuss the issue.
E) A 38-year-old woman who is experiencing severe abdominal pain.

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You’re a SHO in a busy clinic. A teenager comes in with a suspected STI, requesting treatment. The teenager’s parents, who are unaware of the sexual activity, come to you asking for details about their child’s condition. The teenager has asked you not to disclose any information to the parents.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Assure the teenager that under no circumstances would you disclose any information without their consent.
D) Tell the parents about the teenager's condition, as this could potentially benefit the family dynamic.
C) Give the teenager the required treatment, knowing that the parents might find out later on.
A) Politely explain to the parents that you cannot provide information without the teenager's consent.
B) Discuss with a senior physician if the parents insist on knowing.

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You are an on-call junior doctor in a district general hospital. The nurse from a nearby nursing home calls and explains that one of their residents, a 95-year-old man with advanced dementia, appears acutely unwell and they suspect he might have a chest infection. They have contacted his family’s private doctor who told them to reach out to the on-call doctor for assessment and possible hospital transfer.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Decline to assess the patient as he is not directly under your care and suggest that the private doctor attends to him.
C) Agree to help if you are able, but let the nurse know that they should have a protocol for such situations.
D) Assess the patient but charge the nursing home for your services.
E) Contact a responsible person (e.g. the duty manager) to clarify about your role in such cases.
B) Evaluate the urgency of the situation, based on the information given, and prioritize according to your other tasks.

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You are working in the paediatric department and are approached by a parent who is desperate to understand the specifics of their child’s rare genetic disorder. You’ve never encountered this condition before and the primary paediatrician is not available over the weekend. The parent seems to be very worried and distraught.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Gather as much information about the genetic disorder from reliable medical sources and provide the parent with a simplified explanation.
B) Explain that you do not have detailed knowledge about the disorder and recommend they consult with the primary paediatrician.
D) Listen to the parent's concerns, reassure them, and promise to arrange a meeting with the primary paediatrician at the earliest.
E) Politely decline to discuss the child's condition until the primary paediatrician is available.
A) Ask the nurse to go through the medical records and provide an explanation to the parent.

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You are BST-Medicine Trainee doctor working in a hospital. One of your patients is a terminally ill cancer patient who is in a lot of pain. The patient has requested a higher dose of painkillers than you are comfortable prescribing. You are worried that the higher dose could lead to respiratory depression and hasten the patient’s death.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Consult with the senior doctor or pain management specialist in charge of the patient's care.
D) Refuse to prescribe the higher dose of painkillers and explain the risks to the patient.
A) Discuss the situation with the patient's family members and ask for their opinion.
E) Delay the decision and continue with the current dose of painkillers.
C) Follow the patient's wishes and prescribe the higher dose of painkillers.

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You are an SHO in gastroenterology and have performed several colonoscopies before. A patient on your ward is scheduled for a colonoscopy, and you are asked to obtain consent. However, you remember that consent can be found invalid if the patient isn’t warned about significant complications.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Refuse to perform the procedure as only registrar or above should consent.
D) Complete a formal written consent form.
C) Obtain verbal consent with a nurse as a witness.
B) Obtain legal advice before consenting.
A) Obtain verbal consent and document that the patient has been consented in the notes.

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You are working as a junior doctor at night in the emergency department when you are asked to clerk a patient who is unable to speak English and there are no available interpreters on hand.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Make an educated guess based on the patient's non-verbal cues and limited communication.
D) Ask the patient to write down their symptoms and use an online translation tool.
B) Proceed with a physical examination and base your diagnosis on the findings.
C) Wait until an interpreter can be present before attempting to clerk the patient.
A) Use a translation app on your phone to communicate with the patient.

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You are a junior doctor working in a geriatric ward. A patient with limited English proficiency is admitted under your care. Her granddaughter, who speaks fluent English, is accompanying her. As you start to take the patient’s history, you suspect that the granddaughter is omitting important pieces of information during translation.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Request assistance from a fellow staff member who speaks the same language as the patient.
C) Politely ask the granddaughter to translate the patient's words as accurately as possible.
B) Ask the granddaughter to leave and attempt to communicate with the patient without an interpreter.
E) Determine whether the patient is comfortable with her granddaughter acting as the interpreter.
A) Arrange another appointment with a professional interpreter.

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You are working as a junior doctor in the emergency department when a patient arrives with chest pain. The patient’s symptoms suggest a possible heart attack. You are asked to call the on-call cardiologist to discuss an urgent coronary angiogram. Amidst the chaos of the ED, you forget and remember to call the cardiologist 45 minutes later.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Ask your senior to call the cardiologist directly.
B) Inform your senior about the delay and call the cardiologist immediately to discuss the angiogram.
A) Call your own consultant and ask for advice first.
D) Call the cardiologist and explain that the senior doctor wants the angiogram but you think it's likely to be angina.
C) Call the cardiologist and say that the senior doctor only just asked you to arrange the angiogram.

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You are a Senior House Officer in the geriatric ward and are about to finish your shift when a new patient with dementia is admitted. The patient’s caregiver provides a list of several daily tasks necessary for the patient’s care. However, the patient seems agitated and confused.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Ask the nurses to attend to the patient and deal with the tasks while you finish your remaining work.
B) Leave and delegate the tasks to the night shift team.
D) Prioritize tasks based on their immediate importance and complete those before handing over to the next shift.
A) Suggest the caregiver to stay and assist the patient until the night shift team arrives.
E) Try to complete all the tasks yourself before leaving.

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You are SHO in gastroenterology taking care of a patient who is scheduled for discharge later today. During the patient’s stay, an abdominal CT scan was performed due to unexplained weight loss. While the scan didn’t find a specific cause for the weight loss, it did reveal a kidney mass of unknown significance, with a recommendation for follow-up imaging.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Personally call the patient's GP to inform them about this finding.
D) Inform the ward clerk to communicate the report findings to the patient.
C) Discuss the issue with the patient and make sure he understand they need to see his GP to schedule a follow-up CT scan.
A) Highlight the incidental finding and the need for a follow-up scan in the discharge letter using capital letters.
E) Recommend that the patient return to the gastroenterology clinic to see your consultant for further evaluation of the mass.

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You are the research associate for a clinical trial studying a new antihypertensive medication. A patient with long-standing hypertension and anxiety is scheduled for a regular clinic visit. This patient’s medical history makes her a good candidate for the study, but she is known to have severe anxiety related to medical procedures and changes in her treatment.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Proceed with enrolling her into the clinical trial, but wait until after her regular clinic visit to obtain consent for her participation.
A) Since she is already anxious, briefly explain the clinical trial and ask her to sign the consent form without going into details.
C) Try to alleviate her anxiety by explaining that her participation in the trial could lead to the development of more effective antihypertensive treatments.
E) Do not include the patient in the study due to her level of anxiety.
B) Explain the potential benefits and risks of the new antihypertensive medication, emphasizing that her total risk from the procedure would not significantly increase.

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You’re a junior doctor working in a pediatric ward. A couple brings in their 5-year-old son who has a serious congenital heart condition. They feel your consultant has not thoroughly explained the benefits of a risky, but potentially life-saving surgery, and they’re considering refusing the procedure.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Defend your consultant's experience and wisdom, explaining that the consultant would only recommend a procedure if it's in the best interest of the patient.
A) Empathize with the parents' concerns and offer to have a meeting with them and the consultant to further discuss the matter.
E) Suggest that the family might want to consult with their religious or spiritual advisor about the ethical implications of refusing treatment for their child.
C) Listen to the parents' worries and ask for more details about what exactly they don't understand or are concerned about.
D) Tell the parents that you can arrange for a second opinion from another specialist in pediatric cardiology.

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You’re part of a medical team handling a COVID-19 ward. Another medical intern, Sarah, consistently leaves her shift early, often leaving patient charts incomplete. You’ve frequently found yourself staying late to finish Sarah’s documentation, which is adding to your already considerable workload.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Insist that Sarah arranges a meeting with the ward's senior doctor and head nurse to discuss her inability to complete tasks.
E) Report the issue to your consultant.
B) Approach Sarah to discuss the problem, ask if she's facing any issues that are preventing her from completing her tasks.
C) Tell the other interns not to assist in completing Sarah's tasks to teach her a lesson.
A) Delegate some of Sarah's unfinished tasks to another intern without discussing it with Sarah.

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You’re the on-call medical intern in a busy ER. With the sudden influx of patients, you delegate an IV line placement to a nurse. The nurse refuses to place the line on a patient who has Hepatitis C.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Ask the nurse about her specific concerns and discuss potential solutions to increase her comfort level.
B) Explain to the nurse the professional duty to provide care to all patients.
C) Place the IV line yourself.
A) Assign another nurse to place the IV line, but avoid telling them about the patient’s Hepatitis C status to prevent fear.
D) Threaten the nurse with a report to the supervisor if she refuses to place the IV line.

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You are a psychiatry junior doctor in a busy outpatient clinic. You have a flight to catch for an important conference the same evening. There are still two patients left to be seen. One patient has a history of long-standing, well-controlled bipolar disorder, and the other patient, who is always accompanied by their family, often raises complex social issues that require time to address.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Spend as much time as needed with the patients, addressing all their questions and concerns, even if it means missing your flight.
B) Inform the clinic nurse that the patients will need to be rescheduled to the next available appointment date and leave for your flight.
C) Conduct a quick assessment of each patient, without engaging in any detailed conversations.
A) Request the clinic nurse to ask the families to leave so you can finish your consultations quickly.
D) Explain to the patients and their families that you are running short on time today, and assure them that someone will be available to address any remaining questions at their next appointment.

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You are interested in cardiology and have been asked to ‘scrub in’ and assist with a coronary angioplasty. The cardiologist is willing to spend longer with you in the cath lab provided that you consent the patient. You have not obtained consent for a surgical procedure before, but understand about some possible complications.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Ask the cardiologist to run through the procedure with you before consenting the patient.
C) Admit to the patient that you are unfamiliar with consenting for the procedure but that he can ask the cardiologist later on if he has questions that you cannot answer.
E) Ask the medical registrar to consent the patient.
D) Refuse to consent the patient.
A) Attempt to consent the patient, and refer any specific questions to the anaesthetist who will conduct a preoperative assessment later on.

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You are asked to speak to a new patient who is a heavy drinker and has been admitted following an episode of severe alcohol withdrawal. He insists he is fine and wants to leave the hospital, despite showing symptoms of delirium tremens.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Avoid engaging with the patient as he is likely under the influence and may not be cooperative.
C) Call his family members to influence his decision.
B) Explore his reasons for wanting to self-discharge.
D) Discuss with the nursing staff if there's any approach that might be causing his restlessness.
A) Explain the severity of his condition, the dangers of discharge, and emphasize the risk of serious complications if he were to self-discharge.

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You are attending to a teenager in the A&E who has been admitted with signs of suspected alcohol poisoning. The physical examination shows signs of acute intoxication, and you also note that the teenager’s parents appear to be distressed and emotional. You are now considering what to document in your medical notes.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Write a brief summary of your clinical assessment.
C) Conduct a detailed physical examination and objective clinical assessment of the teenager.
E) Document your opinion of the parents’ emotional state, based on their appearance.
A) Complete your notes after they have been confirmed by a senior doctor.
D) Complete your notes later after attending to other patients, to keep the clinic moving.

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While you are working in the Emergency Department (ED), you are inserting a chest tube in a patient with a suspected pneumothorax. Just as you are about to secure the tube, your emergency pager goes off for a potential cardiac arrest in the next bay.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Ignore the pager as they will call again if it is important.
C) Secure the chest tube and ensure it is functioning correctly before responding to the emergency pager.
E) Try to get the attention of the ED Charge Nurse so that she can respond to your pager.
D) Stop your current procedure immediately and attend the cardiac arrest.
B) Respond to your pager after securing the chest tube, cleaning the work area, ensuring the patient is stable and handing over to the nursing staff.

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You’re a junior doctor in an Oncology department. A young woman newly diagnosed with cervical cancer confides in you that she doesn’t want her traditional family to know about her diagnosis, fearing their reactions and possible ostracism.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Inform the nursing staff that her family is not aware of her diagnosis and to be cautious about disclosing information.
E) Treat her with the same protocols and privacy measures as any other patient in your care.
A) Assure her that you will not include her diagnosis on patient lists visible to non-medical staff.
D) Promise her that you will not mention cervical cancer in her medical records.
B) Inform her that her family is likely to discover her condition eventually, so it would be better if she informs them.

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While working the night shift in the Intensive Care Unit, you notice Bob, one of the nursing assistants, speaking in a harsh manner to a patient with severe Alzheimer’s disease. This patient can often be challenging due to his cognitive impairment and behavioural issues.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Don't act on the situation as the patient's cognitive impairment might make him unaware of the treatment.
E) Report the behavior to a senior nurse on shift.
B) Discuss with other staff if they've noticed Bob's inappropriate behavior.
D) Speak to Bob directly about his behavior.
C) Report the situation directly to hospital administration.

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A patient who was admitted for heart failure is unhappy with the lack of communication and attention from the medical team over the past few days. She is considering filing a formal complaint and discusses this with you.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Engage her in a conversation to understand the events that have led to her dissatisfaction.
D) Inform your senior that the patient is contemplating a complaint.
C) Give her the contact information for the Patient Advice and Liaison Service (PALS) to explore their options.
B) Explain to the patient that due to understaffing issues, the level of attention might be lower than usual, and a complaint could potentially instigate improvements.
A) Advise the patient that filing a formal complaint might not bring about the desired changes.

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You are an intern working in the orthopedic department. Your consultant requests you to consent a patient whom you have just examined in the emergency department for a possible femoral head replacement due to an acute hip fracture. Your consultant needs to attend to another emergency case and cannot consent the patient himself.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Contact the medical consultant on call.
D) Request an orthopedics SPR who has performed the operation in the past to take the consent.
C) Request the consultant to get in touch with a senior colleague who is off-duty.
E) Ask the consultant to consent the patient as soon as he is done with the current emergency case.
B) Attempt to take the consent as best as you can.

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You are about to conduct a bedside teaching session with a patient who has advanced liver cirrhosis. The patient, with distinct clinical signs, has given his consent to aid the teaching session for your medical students. However, as you and your students approach his room, you notice that the patient looks visibly distressed and upset.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Inquire with the patient if he still feels comfortable assisting in the teaching session with the medical students.
B) Decide not to enter the room, presuming he may no longer agree to be a part of the teaching session given his state of distress.
C) Educate the students outside the room that emotional distress is common in patients with a terminal illness.
E) Approach the patient first to discuss his feelings and see if there's anything you could do to assist him.
A) Continue with the planned session hoping that it could distract him from his current emotional state.

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Linda has recently been diagnosed with rheumatoid arthritis. During her outpatient clinic visit, she asks her rheumatologist to explain what this means, and the rheumatologist says that you, as a resident, will talk to her later about the condition.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Hand Linda a patient information brochure provided by the clinic.
C) Inform Linda that "rheumatoid arthritis" essentially means that the joints are inflamed due to the body attacking itself.
D) Ask Linda what she understands so far and what she wants to know.
B) Advise Linda that there are some excellent resources online and she should research more about the condition once she is home.
A) Tell Linda that "rheumatoid arthritis is an autoimmune condition in which the body's immune system mistakenly attacks the joints."

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The oncology nurse asks you to discuss the next steps with Tom, a patient who was recently diagnosed with a terminal cancer. You were away for a medical conference for the last week and are not aware of Tom’s prognosis or treatment history. All your seniors are currently in a critical patient review and you are the only doctor available on the ward.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Join the conversation with Tom but refrain from answering any medical queries.
B) Request the oncology nurse to summarise Tom's case history before meeting him.
E) Enter the meeting with Tom and catch up on the case as the nurse converses with him.
D) Ask the oncology nurse if she can postpone the meeting until your seniors are free as they are more acquainted with Tom's case.
A) Agree to converse with Tom, after reading his medical notes thoroughly.

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Dr. Smith, the senior consultant, has asked you to arrange a lumbar puncture procedure for a patient with a suspected neurological condition. However, when booking the procedure, you only find the option for ‘CT-guided lumbar puncture.’ He instructs you to book this and later inform the department to amend the request. You have reservations about this strategy due to prior experiences with incorrect procedures being carried out.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Book a CT-guided lumbar puncture procedure and then call the department to amend your request.
A) Submit a clinical incident report concerning Dr. Smith's apparent readiness to compromise patient safety.
B) Request Dr. Smith to arrange the procedure under his name.
E) Contact the procedure department first, then book the 'CT-guided lumbar puncture.'
D) Express your reservations and recount previous incidents where such strategy has led to errors.

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Your head nurse is about to administer a complex set of medications to a critical patient. She has a reputation for being a bit harsh and earlier she asked you to keep quiet while she is preparing the medications. Although you have been somewhat distracted, you believe you saw her preparing an excessive dose of one drug, but you are not entirely sure.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Ask an indirect question such as: "What would be the effects if a high dose of this drug was given?"
D) Ask a random question to lighten the atmosphere before discussing the possibility of an overdose.
A) Cross-check the patient's medication chart yourself.
B) Keep silent as you were not completely attentive.
C) Immediately point out your concern to the head nurse.

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You are a GP Trainee and your clinical supervisor has agreed to complete an evaluation for your rotations but hasn’t done so yet. The deadline for submitting all evaluations is fast approaching.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Inform the National GP Training Director that you are having trouble getting evaluations done.
C) Remind your supervisor about the approaching deadline.
B) Approach a different supervisor to complete an evaluation.
A) Inform your Local Scheme Director about the difficulty you're experiencing in getting evaluations.
E) Ask for your supervisor's login details to fill in the evaluation form yourself.

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You have just concluded an emergency case presentation for Mrs. Davis, a 68-year-old woman with severe chest pain, to Dr. Bennett, the on-call cardiology consultant. The next morning, Dr. Silva, the new on-call cardiology consultant, reviews your case presentation and proposes an entirely different treatment plan, without additional information or examining the patient. You are uncomfortable with Dr. Silva’s suggestions.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Politely refuse to implement Dr. Silva's treatment plan until she examines Mrs. Davis.
C) Proceed with Dr. Silva's treatment plan.
D) Discuss the discrepancies between Dr. Bennett's and Dr. Silva's proposed treatment plans.
E) Request clarification from Dr. Silva regarding who is ultimately in charge of the case.
A) Request the registrar to review Mrs. Davis for a 'third opinion'.

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Rachel, a 75-year-old lady with a history of moderate dementia, has been in the hospital for a few weeks following a hip fracture. With the help of the physiotherapy team, she has recovered her mobility to her usual baseline. Her family, however, express several concerns to you that they feel need to be addressed before Rachel is discharged.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Consider her brother's worries that her memory loss is deteriorating and that she needs additional medical care.
B) Support Rachel's niece, who feels that Rachel needs help managing her apartment.
C) Discuss the family's concerns with Rachel, and seek her point of view first.
A) Arrange residential care home as requested by her sister.
D) Address her daughter's worries about potential financial exploitation by a supposed friend, using appropriate assessment tools.

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You have planned a bedside teaching session for a group of five medical students with a patient on your ward suffering from rheumatoid arthritis. When you arrive, you find her extremely upset due to a flare-up of her condition and an ongoing argument with her insurance provider. You had previously agreed to spend an hour with the patient and students, and you don’t have any other patient available for the teaching session.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Emphasize that emotional stress is a typical part of chronic illnesses, and continue with the bedside teaching as planned.
D) Use the situation as a teaching moment in communication skills by discussing her insurance troubles.
E) Disregard the problem and focus your teaching strictly on the examination of the patient's rheumatologic signs.
A) Switch to teaching the students medical theory in a lecture room instead
C) Start the teaching, but agree to stop if her distress continues.

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You are an intern working in a cardiovascular ward, and during the morning round, you notice a patient looking quite anxious. The attending cardiologist notes that understanding the cause of this anxiety is crucial before discussing any potential treatment options. You ponder how you might proceed to address this.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Schedule a 20-minute dedicated conversation with the patient to talk about any worries or concerns.
A) Request the nurse assigned to the patient today to find out what's bothering the patient.
D) Reach out to the family members to try to gain insight into the patient's worries.
E) Leave it up to the patient to discuss their concerns voluntarily, without any prompting.
C. Ask the ward clerk to talk to the patient and try to identify any issues.

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You are an intern in a geriatric ward. Robert is a patient with early-stage Alzheimer’s who is refusing to take his prescribed medications, despite your recommendations and his son’s pleas. His son tells you about a previous prolonged discussion between other doctors and his father, which resulted in Robert eventually being “overridden,” and asks you to avoid similar delays and start the medication right away.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Evaluate Robert's capacity to refuse this treatment.
A) Ask the son to assist in your assessment of Robert's capacity.
E) Review the medical records to determine whether Robert lacks the capacity to make this decision.
D) Proceed with the treatment despite Robert's objections.
B) Avoid making a decision and seek the advice of a senior colleague.

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You are seeing Olivia, a 35-year-old woman. She mentions to you about her friend who was recently diagnosed with diabetes. This news has alarmed her, and Olivia is concerned about her own risk of developing diabetes. She read some articles online and now wants a complete panel of blood tests.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Explain that her absolute risk of developing diabetes is low.
D) Order a complete panel of blood tests.
E) Prescribe medication for anxiety.
A) Explain the drawbacks and invasiveness of unnecessary blood tests.
C) Conduct a thorough health history and physical examination.

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You are currently doing rounds on the geriatric ward with your SHO. Both of you have numerous tasks that need to be completed by the end of the shift. Your SHO asks you to postpone referring Mr. Smith, a patient suffering from severe shortness of breath, to the respiratory team until the next day, due to the high likelihood of needing to perform a bronchoscopy, which will lead to additional tasks that are time-consuming. You are concerned as Mr. Smith appears to be in increasing discomfort.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Follow your colleague’s instructions and make the referral to the respiratory team the following day.
D) Report to your consultant that the SHO is neglecting Mr. Smith.
B) Finish the list of tasks assigned by your SHO before referring the patient to the respiratory team later in the day.
A) Assign the task of referring the patient to a nurse, even though you are aware that 'doctor-to-doctor' referrals are generally expected.
E) Discuss the importance of timely management of severe respiratory symptoms with your SHO and propose a rearrangement of tasks.

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You are an intern in your first month working on the gastroenterology ward. You have grown increasingly concerned about your registrar’s abilities. You have noticed her incorrectly interpreting fundamental clinical signs. Once, you attempted to express your concerns to the consultant, but he dismissed them, emphasizing the registrar’s expertise in endoscopic procedures.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Discuss the matter with your Educational Supervisor.
E) Ask the registrar if she would be open to receiving some additional teaching from you after hours.
A) Report the issue to the Clinical Director.
B) Reiterate your concerns to your consultant, emphasizing the registrar’s overall performance.
C) Share your concerns with another intern.

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You are reviewing patients in the Accident and Emergency Department (A&E). A former classmate from medical school approaches you and informs you that his mother is one of the patients waiting to be reviewed. He asks you to see his mother first.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Report your medical classmate to his training coordinator.
E) Review your classmate's mother last, as a form of reprisal for his inappropriate request.
C) Reject your classmate's request immediately.
B) Determine if there is a specific reason why he wants you to see his mother immediately.
A) Consult with the registrar to see if they have a preference for which patient you should see next, and if not, begin with your classmate's mother.

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Emma is a 30-year-old patient with Multiple Sclerosis. Upon checking her medication chart, you notice several missed doses of medication. When you inquire with the nurse who’s been overseeing Emma since her admission, she says that the patient has been declining to take her medication. However, Emma has always been cooperative with you and denies ever being given the medication by the nurse.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Suggest to the nurse that she spends time with Emma and motivates her to take her medication.
D) Report the nurse to the Nursing and Midwifery Council.
A) Convert all of Emma's medication to intravenous forms.
C) Inform the Incharge Nurse that Emma hasn't been receiving her medications and request for further investigation.
B) File a clinical incident report for the failure to adequately encourage Emma to take her medication.

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Mrs. Martinez, an elderly patient with advanced Alzheimer’s disease, has been admitted for recurrent urinary tract infections. During her admission, you come across an indefinite DNAR (Do Not Attempt Resuscitation) order that has been in place since her previous admission. Upon speaking to Mrs. Martinez’s daughter, who is her primary caregiver, it appears that she is unaware of the existence of this order.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Explain the reasoning behind the DNAR order, given Mrs. Martinez's condition.
A) Invalidate the DNAR order.
B) Inform your senior about the situation immediately.
E) Avoid informing Mrs. Martinez's daughter about the DNAR order for the time being, and opt to discuss it later with her privately.
C) Apologize for the lack of communication from Mrs. Martinez's previous doctors.

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You are a new physician in an outpatient clinic. During a routine check-up, Mark, a 42-year-old commercial airline pilot, reveals to you that he has recently been experiencing occasional blackouts. Although he promises to avoid flying until the issue is resolved, you overhear him telling his wife on the phone that he doesn’t want to jeopardize his job and plans to continue his regular flying duties.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Seek assurance from Mark's wife that he will not fly.
D) Inform Mark's primary care provider about the situation.
A) Ask Mark to sign a written agreement not to fly until the blackout issue is resolved.
B) Inform the Aviation Medical Examiner (AME) about Mark's condition.
E) Accept that you are not responsible for the patient's actions once you have appropriately instructed him.

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You are working as senior house officer in a cancer hospital. A 45-year-old father of three, Mr. Jackson, notices you as you pass by his room. He looks worried and calls you in. He has recently had a biopsy for a suspicious lung mass and asks, “What if it turns out to be lung cancer?”

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Validate his concern, saying, "I understand you are worried about the possibility of having lung cancer."
B) Comfort him with words that everything will turn out to be okay.
D) Request Mr. Jackson to hold his queries and direct them to your senior doctor.
A) Remain silent and look away, attempting to indicate the severity of his situation without words.
C) Reassure Mr. Jackson that the medical team will do everything in their capacity to treat his condition.

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You are caring for George, an 83-year-old patient in a nursing home who has moderate dementia. During your rounds, he shares with you that he dislikes having the nursing staff bathe him each evening. He tells you that at home, his caregiver used to be present while he bathed, stepping in only if he needed assistance. This process was slower but he preferred it that way.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Assure George that he can bathe himself each evening if he wants, with supervision if needed.
E) Relay George's request to the Charge Nurse and suggest that it be mentioned during the nursing handover.
A) Inform George that he could resume his preferred routine once he gets back home.
B) Tell George that you have no authority to change how the nursing home operates.
C) Explain to George that it may not be feasible as the nursing staff are often busiest in the evenings.

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You walk into the hospital room to find an intern physician conducting a physical examination on a female patient with the door wide open. The patient does not seem to express any discomfort.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Ask the patient for her preference and leave the door open if she is comfortable with it.
E) Explain the importance of patient privacy to the intern afterward, if there seems to be a misunderstanding.
A) Continue with your work as there doesn't seem to be an issue and you shouldn't interfere.
B) Close the door quietly.
C) Publicly tell the intern that he should learn to respect privacy.

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During your daily rounds on the oncology ward, your registrar informs a patient that he will need a ‘Whipple procedure’, which would involve removal of part of his pancreas and other organs. The patient signs a consent form, but from his expressions, it seems he still has some queries but doesn’t voice them.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Assure the patient that you will return after the rounds to answer any further questions he may have.
A) Inform the patient that the registrar will return later to address his concerns.
B) Move ahead with the rounds but plan to revisit the patient later to answer any queries.
E) Continue with the rounds but stay behind to draw a diagram of the Whipple procedure for the patient.
D) Demand that the registrar stay back to answer the patient's queries.

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You are making rounds on a busy hospital floor when you notice an elderly patient struggling to reach the call button on the bedside table.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Yell from your place to the patient, guiding him how to properly hold the bottle.
D) Go to the patient, take the bottle and hand it over to him without any discussion.
C) Report the situation to the nurse assigned to that patient.
E) Tell the patient that he needs to be more cautious about placing the bottle within his reach.
B) Approach the patient and ask if he needs help with his water bottle.

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During your shift at a psychiatric hospital, you’re asked to prescribe a safety helmet for a particular patient. The helmet is designed to prevent self-harm through head banging. You agree to prescribe it only under certain conditions.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) The patient lacks capacity and has a history of self-harm through head banging.
E) The patient lacks capacity and has a history of self-harm through head banging. However, the patient's family strongly opposes the use of a safety helmet.
B) The patient lacks capacity to understand his own actions.
A) The patient exhibits periodic outbursts of anger.
D) The patient lacks capacity, has harmed himself before by head banging, and all other preventive strategies have failed.

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A patient admitted to your ward with a highly contagious gastrointestinal virus has been asked to remain in his room as much as possible and adhere to strict hygiene practices. He also has been informed that public health authorities must be notified about his condition. However, he refuses to allow his health information to be shared and frequently leaves his room without practicing recommended hygiene measures.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Explain to the patient that his disease is highly contagious and could easily infect others in the hospital.
A) Discharge the patient from the hospital without further treatment, as his behavior could put others at risk.
B) Try to understand why the patient is not following the recommended protocols.
C) Despite the patient's objections, submit his details to the public health authorities.
E) Assure the patient that his information won't be shared externally, but insist that his primary healthcare provider must be notified.

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Maria is an elderly woman with severe Parkinson’s disease who often wanders around the care home during the night. Her mobility is unpredictable, and she can become agitated and combative when caregivers try to guide her back to her room.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Suggest engaging activities, such as puzzles or gentle exercise, to divert her attention.
A) Discuss with Maria, as much as she can understand, that it's not safe for her to wander around unattended.
D) Request that a dedicated caregiver be assigned to monitor her one-to-one during night hours.
C) Prescribe 'as needed' (PRN) medication for agitation.
E) Prescribe medication to be given when Maria becomes particularly agitated and poses risk to herself or others.

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A patient informs you that they suspect their nurse has been accessing their medical records without permission.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Report the incident to the hospital's privacy officer or designated authority responsible for handling privacy breaches.
D) Request the patient to gather any evidence or specific incidents of unauthorized access before escalating the situation.
B) Verify the patient's claim by reviewing access logs and confirming any unauthorized activity before taking further action.
E) Inform your supervisor or department head about the patient's concerns and seek.
A) Ask the nurse to provide an explanation and disclose any unauthorized access to the patient's medical records.

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You are on a surgical ward and notice a nurse administering medication to a patient, but you suspect she may have accidentally given the wrong dose.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Discuss your concerns with another nurse or senior colleague to get a second opinion.
A) Immediately intervene and stop the nurse from administering any further medication.
E) Confront the nurse directly and question her about the possibility of administering the wrong dose.
D) Report the incident to the charge nurse or nurse manager responsible for the ward.
B) Observe the situation closely and double-check the medication order to confirm if there was an error.

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You are conducting a routine check on the patients’ vital signs and notice that one of the patients who requires oxygen therapy is not receiving it, even though it was prescribed by the doctor.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Inform the nurse in charge about the situation and the missed treatment.
E) Monitor the patient closely for any signs of distress and wait to see if the nurse eventually administers the oxygen.
C) Double-check the patient's medical records and prescription to ensure the correct oxygen therapy is prescribed.
D) Confront the nurse responsible for the patient and insist on administering the oxygen therapy right away.
A) Immediately provide the patient with the prescribed oxygen therapy.

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You are a junior doctor in the obstetrics and gynecology department. As all the interns are changing jobs, the ward clerk asks you to complete a discharge summary for a patient who was discharged last week after a complicated delivery, including arrangements for follow-up.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Write a letter to the previous intern in the obstetrics department and ask them to complete the discharge summary for their patient.
A) Refuse and ask the ward clerk to find the doctor who was looking after the patient.
B) Ask the new SHO in the obstetrics department to try to complete it.
C) Attempt to complete the discharge summary and try to find the consultant or registrar on duty to discuss and confirm the follow-up arrangements.
E) Complete the discharge summary to the best of your ability and arrange a routine follow-up appointment in the obstetrics clinic in six weeks.

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During a ward round, you notice that one of your senior colleagues is consistently speaking to patients in a condescending and disrespectful manner. A patient approaches you and expresses their discomfort with the way the senior colleague communicates. They do not wish to file a formal complaint, but they suggest that you take action regarding the colleague’s behavior.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Inform the hospital's patient advice and liaison service (PALS).
D) Establish specific instances and details of the colleague's disrespectful behavior.
C) Apologize to the patient and assure them that you will address the issue with the senior colleague.
A) Raise the concern privately with your senior colleague.
E) Explain that the senior colleague may have had a bad day and that patients should understand the challenges doctors face.

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You are working with a registrar who unintentionally prescribes a medication that the patient is allergic to, but you catch the error before it is administered. The registrar expresses relief and acknowledges that both the patient and themselves had a fortunate escape.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Apologize to the patient for the error and assure them that necessary measures will be taken to prevent a recurrence.
E) Conduct a root cause analysis to identify the underlying factors contributing to the prescribing error.
B) Inform the hospital's patient safety officer about the incident.
C) Discuss the incident with the registrar privately and provide guidance on double-checking prescriptions.
D) Document the incident in the patient's medical records.

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You have recently joined a surgical team as a NCHD(Non-Consultant Hospital Doctor). During the surgical rounds, you have noticed that some team members frequently make inappropriate jokes and derogatory comments about patients based on their ethnicity or other personal attributes. These comments create a disrespectful and unprofessional environment.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Arrange a meeting with the entire surgical team to discuss the importance of maintaining a respectful and inclusive environment.
E) File a formal complaint with the hospital's HR department.
D) Report the behavior to your immediate supervisor or department head.
C) Speak privately with the team members involved and express your concerns about their inappropriate comments.
A) Ignore the comments and focus solely on your own work.

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You are junior doctor working in a busy emergency department. One of your colleagues, Sarah, has been displaying signs of increasing stress and fatigue. She has been making more errors in patient management and appears overwhelmed. You are concerned about her well-being and the potential impact on patient care.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Document any incidents or errors related to Sarah's performance.
D) Offer assistance to Sarah in managing her workload or seeking support.
E) Discuss the situation with a senior colleague or supervisor for guidance.
B) Approach Sarah privately and express your concern for her well-being.
A) Ignore the situation and hope that it resolves on its own.

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George is an elderly gentleman who suffers from COPD and is under your care in the respiratory ward. He is on continuous oxygen therapy and needs assistance to move around due to breathlessness. It takes considerable effort to get him to the toilet, which often turns out to be unneeded as he does not always feel like going afterward.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Ask George for his views and whether he is bothered by the numerous trips to the toilet.
E) Tell George that he needs a urinary catheter and then place it carefully.
D) Explain the problem to George and then propose using a urinary catheter once he consents.
C) Consult with the pulmonology team to see if there are any additional interventions that can be done to manage George's breathlessness.
B) Suggest alternatives such as a bedside commode or a urinal bottle.

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You are a senior house officer working in a busy hospital ward. One of your colleagues, Mark, frequently neglects his ward duties to spend more time in the operating theater. Except for the morning rounds, you haven’t seen Mark on the ward for at least five weeks. The registrar seems to be okay with this arrangement as long as the tasks are completed, and you don’t have a particular interest in theater.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Talk to Mark and suggest dividing theater and ward time more evenly.
D) Suggest that SHO's should be prohibited from assisting in the operating theater.
B) Speak to Mark and insist that he spends more time on the ward.
A) Do nothing as you enjoy the ward and Mark clearly wants to be in the operating theater.
C) Go to the operating theater and leave any ward tasks until after hours when both you and Mark can attend to them.

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You are a junior doctor working in a busy hospital. During your shift, you notice a colleague mishandling medications and administering the wrong dosage to a patient. The patient is at risk of harm if the mistake is not corrected.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Report the incident to the hospital's patient safety officer.
A) Immediately intervene and correct the medication error.
B) Inform the nurse in charge about the medication error.
D) Discuss the situation with your senior doctor or consultant.
E) Ignore the mistake and hope that it is not discovered.

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You are GP Trainee working in a busy hospital. Your consultant frequently requests that you perform tasks that are beyond your level of experience and competence. This puts you in a difficult position as you want to provide the best care for your patients while also respecting your limitations.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Continue to accept and perform the tasks assigned by your consultant, even if you feel uncomfortable or unprepared.
A) Speak privately with your consultant and express your concerns about being assigned tasks beyond your level of experience.
D) Discuss the situation with the hospital's medical education department or your educational supervisor.
B) Seek guidance from more experienced colleagues or senior doctors on how to handle the situation.
C) Document your concerns and incidents where you feel your competence has been compromised.

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You work in a busy hospital where the electronic health record (EHR) system frequently malfunctions, causing delays and errors in patient care. The system crashes at least once a week, leading to frustration among healthcare professionals and potential harm to patients.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Seek guidance from a more experienced healthcare professional on alternative approaches to ensure patient safety during EHR system failures.
B) Document specific instances of patient care delays and errors caused by the EHR system malfunctions and report them to your Clinical Supervisor.
A) Bring up the issue with the hospital's IT department and request immediate resolution of the EHR system problems.
C) Engage with colleagues and organize a meeting to discuss the impact of EHR system issues on patient care and workflow.
E) Ignore the EHR system issues and continue working with the flawed system to avoid causing disruptions in patient care.

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You notice a conversation between two of your medical trainees, Sarah and Lisa. Sarah recounts a recent incident where she self-prescribed medication to help manage her chronic condition after losing her regular prescription. She appears to be unaware that this is an issue and hasn’t indicated that she plans to tell anyone about this.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Inform Sarah that you will be reporting her to the Irish Medical Council.
D) Ignore the issue as it appears Sarah was trying to manage her health responsibly and didn’t intend any harm.
E) Ask Lisa for more details about the incident.
B) Schedule a meeting with Sarah’s training program director to discuss what you heard.
C) Talk to Sarah about what you heard, and whether she understands the regulations related to self-prescribing.

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During a busy clinic session, you notice your registrar with an acute headache. She informs a nurse that she forgot her migraine medication at home. She then receives a dose of sumatriptan from the clinic’s drug cabinet.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Express your concern to the nurse who gave her the medication.
A) Report the registrar for taking clinic medication.
B) Suggest that she goes to the Emergency Department to get a proper prescription for the migraine medication.
E) Do nothing.
C) Write a prescription for the sumatriptan for your colleague.

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You realize that a fellow doctor is having difficulty interpreting ECGs, despite being well into her training program.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Call the registrar urgently to share your worries about her.
A) Offer to tutor your colleague on ECG interpretation and recommend relevant educational resources.
C) Suggest your colleague to seek assistance from a senior cardiologist.
E) Send an email to her Training Director informing about the situation.
B) Overlook the issue unless a serious misinterpretation happens.

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You are assisting a senior cardiologist during a cardiac catheterizations procedure. You have seen many catheterization during your training, and you are certain that the cardiologist has inadvertently entered the left subclavian artery instead of the right. The cardiologist denies this, and when you ask him to confirm the entry point, he seems uncertain.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Ask the anesthesiologist to become involved.
A) Accept that the cardiologist is much more experienced and likely correct.
E) Excuse yourself from the procedure room and contact the head of the department, asking him to come to the operating room.
C) Wait until the procedure is completed before discussing the issue with the head of the department.
D) Insist that the cardiologist stops as you are confident a mistake has been made.

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You notice that Mark, a recently hired Physician Assistant, has ordered an unnecessary blood transfusion for a patient. Mark is adamant that the transfusion is necessary, even after you express your concerns. He cites his “years of experience” in justifying his decision.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Agree to the transfusion but plan to discuss with the patient's GP to cease such orders in the future.
A) Explain your reasoning as to why you believe the transfusion is not necessary.
E) Consent to the transfusion but don't sign off on the order.
B) Affirm your disagreement and halt the transfusion order as you bear the ultimate responsibility for patient care.
D) Notify Mark that you'll consult with a superior colleague about the matter, and in the meantime, the transfusion should not proceed.

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Peter is a geriatric patient on the cardiac ward who is currently attending bi-weekly physical therapy sessions. After evaluating him, you believe he may benefit from more frequent sessions.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Ask the physical therapist whether they think Peter could benefit from more frequent sessions.
C) Involve Peter and his family in a meeting with the interdisciplinary team to voice their concerns.
A) Stick with the physical therapist's current treatment plan.
D) Discuss your thoughts with other members of the interdisciplinary team before the weekly meeting.
E) Tell the physical therapist that they should increase the frequency of Peter's sessions.

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You are at a busy pediatric clinic and the lead nurse alerts you that a 5-year-old child in one of the examination rooms appears to be having a seizure. You are the most experienced doctor present, but also in the room are a final year medical student, an intern and a porter.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Instruct the porter to bring the emergency seizure medication.
E) Wait for instructions from the nurse.
B) Encourage the intern to lead the seizure management to develop his clinical skills.
D) Ask the intern to bring the emergency seizure medication, while you assess the child.
A) Instruct the medical student to time the seizure.

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You’re the on-call doctor overnight in the hospital and you receive a call from the nurse on the geriatric ward. She insists that you immediately come to review an elderly patient, Mrs. Smith, because she believes the patient is not receiving adequate pain control. You’re currently attending to a critical patient in the ICU and there are still multiple tasks to be completed. The nurse says she will call your consultant if you don’t come immediately, even though you’ve already assessed Mrs. Smith’s pain as well controlled during your last round.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Promise the nurse that you will re-evaluate Mrs. Smith's pain management as soon as you are done with your immediate duties in the ICU.
C) Leave the critical patient in the ICU and immediately attend to Mrs. Smith as per the nurse's request.
E) Tell the nurse that you will hand this over to the morning team.
A) Tell the nurse to call your consultant as you are currently tied up in the ICU.
B) Assure the nurse that you have evaluated Mrs. Smith's pain and found it well-controlled, but promise to discuss it with your consultant during morning handover.

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You are the on-call doctor overnight in the hospital. A nursing assistant pages you for the fifth time in two hours to ask you about minor issues that could have been handled by the regular staff during daytime hours or issues that are not immediately critical.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Explain to the nursing assistant the importance of distinguishing between urgent and non-urgent issues, considering the limited number of on-call doctors.
E) Tell the nursing assistant to stop paging you for non-critical issues.
C) Listen to the page, gather necessary information, and then determine the priority of the task.
B) Accept the page and add the task to your list, regardless of its urgency.
A) Visit the ward and request the charge nurse to triage all further pages from the nursing assistant.

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You are managing a patient who you suspect may have a deep vein thrombosis (DVT). Your consultant has asked you to arrange a Doppler ultrasound to confirm this. However, the radiographer has twice denied your request, first for insufficient clinical detail, and then due to lack of convincing laboratory results. Your consultant insists that the scan needs to be completed today.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Explain to the radiographer that your consultant has evaluated the patient and if they are unwilling to do the same, they should accept the scan request.
A) Decide not to order the Doppler ultrasound scan.
C) Bring the patient's medical records and speak to the radiographer in person.
B) Seek another radiographer's opinion.
D) Discuss the situation with your consultant.

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You are working an evening shift in the emergency department and you have accumulated a substantial list of tasks to accomplish. This includes six ECGs, an urgent lumbar puncture which was due two hours ago, two IV insertions, and three admissions to coordinate. You ponder over how you will get everything done.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Request the help of another junior doctor.
C) Delegate your list of tasks to the ward nurse and ask him to call you if there are any issues.
A) Prioritize the urgent lumbar puncture that was supposed to be done two hours ago and then order the other tasks by urgency.
D) Join your peers in the break room to strategize your tasks and ask for help if needed.
E) Contact the on-call nurse to request assistance while you head to the urgent lumbar puncture.

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You are nearing the end of your GP rotation in Paeds. The position was more demanding than you had anticipated, and you found the initial induction process to be lacking. Now, you’re thinking about ways to assist the person who will take your place.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Leave your personal email address for your successor to reach you if they need help.
C) Inform your Clinical Supervisor about your thoughts on the induction during your end of rotation review.
B) Let the clinical management team handle the induction process.
D) Prepare a guide with useful advice and pointers for your successor.
E) Take time off your upcoming rotation to guide your successor during their initial week.

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You are a junior doctor and have noticed that your registrar often arrives late to the morning handovers. The consultant, who usually arrives after the registrar, is not aware of this. The constant tardiness is affecting the smooth transition of care and you’ve observed other staff members’ growing frustration.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Inform the consultant about the registrar's late arrivals.
C) Start the handover without the registrar when they are late.
D) Propose a "timekeeping agreement" that everyone on the team should adhere to.
B) Speak to the registrar privately to express your concerns about their lateness.
E) Ask the registrar if there are any issues causing their repeated lateness.

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You are a junior doctor in a busy general surgery ward. Your fellow junior doctor, a friend from medical school, has recently taken up a new hobby and leaves work 30 minutes early each day to attend their practice sessions. As a result, you find yourself staying late often to complete pending tasks. You understand the importance of work-life balance, but you’re also starting to feel overwhelmed by the additional workload.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Schedule a meeting with your supervising consultant to discuss the situation.
E) Verify whether the practice sessions are temporary or a long-term commitment.
B) Ask your friend to arrive to work 30 minutes earlier to make up for their early departure.
A) Discuss your concerns directly with your friend and fellow junior doctor.
D) Inform your friend that you'll bring up the issue with your consultant unless they adjust their schedule.

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Your colleague, a junior doctor, is often seen leaving the hospital with boxes of unused gloves and masks. You’re aware that he uses them to practice his clinical skills at home.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Inform his Clinical Supervisor via email about your observations.
B) Confront your colleague, stating that if the action continues, you'll have to report him.
E) Request your colleague to return the hospital supplies immediately.
D) Notify the hospital inventory manager about the missing supplies.
C) Overlook the act considering your colleague's intent is to enhance his clinical skills.

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You are an SHO working in a geriatric unit. After finishing your rounds, you realize that your bag containing patient charts is missing from the staff lounge. These charts contain sensitive information about your patients’ health status.

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

E. Notify hospital security to check for any unusual activity and assist in locating the bag.
D. Ask your colleagues if they noticed anyone suspicious or unfamiliar around the staff lounge.
C. Report the incident to the Garda to start an official investigation.
A. Wait to see if the bag turns up before taking any action.
B. Immediately inform your supervisor about the missing bag and its contents.

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You are an SHO on a geriatric ward, and you’ve been tasked with determining the preferences of Mr. Clarkson, a patient recovering from a severe knee injury, regarding his ongoing care and potential transfer to a rehabilitation facility. Mr. Clarkson has a hearing impairment and communicates through sign language, which you are not familiar with. You also have a series of urgent tasks to complete before an impending consultant ward round.

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

C. Decide on Mr. Clarkson's behalf to transfer him to a rehabilitation facility, considering his physical condition.
B. Wait for Mr. Clarkson's relative who knows sign language to visit later in the day to facilitate communication.
E. Request the assistance of a hospital staff member who is proficient in sign language to communicate with Mr. Clarkson.
D. Contact Mr. Clarkson’s family to understand his usual preferences and wishes.
A. Attempt to communicate with Mr. Clarkson using written notes before addressing other tasks.

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You are at a famous bar in Dublin enjoying your Guinness after hectic hospital routine on Friday night and you hear a group of doctors and nurses from your hospital loudly joking about identifiable patients in their ward.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Speak to the person who is speaking the loudest, so they are aware that their behavior is inappropriate
E) Ignore the situation and not cause a scene.
D) Contact a manager in their department the following working day to alert them to this breach.
C) Challenge the whole group so that they are aware that their behavior is inappropriate.
B) Call hospital security and ask them to intervene.

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What is the appropriate action to take if you are asked to sign an agreement not to raise concerns with bodies outside of your employing organisation during induction at your new hospital ?

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Sign the form and begin work as instructed.
E) Contact your medical defence organization or the IMC for advice if in doubt.
D) Sign the form but resolve to raise concerns about patient safety in whatever way is necessary to ensure their resolution.
B) Throw the form away and hope that no one notices that it was not returned.
C) Explain that you cannot sign as this prohibits you from raising concerns about patient welfare.

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You are a nurse working in a hospital ward. A colleague of yours is refusing to care for a patient with HIV and is making derogatory comments about the patient’s lifestyle. What actions should you take?

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Speak to the colleague directly and explain that their behavior is unprofessional and discriminatory.
C) Confront the colleague in front of other staff and patients to make them aware of their inappropriate behavior.
D) Ignore the situation and continue with your own work.
B) Report the colleague to a senior nurse or manager on the ward.
E) Discuss the situation with a colleague who is not involved in the situation to get their opinion.

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You are a newly qualified doctor starting your first job. You are asked to prescribe a medication for a patient by a registrar, but you notice that the dose is higher than the recommended safe dose. The registrar tells you that this is the dose that they usually prescribe for this patient, and they want to continue with it.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Ask another senior colleague for advice before deciding on what to prescribe.
A) Refuse to prescribe the medication at the dose requested and explain your concerns to the registrar.
D) Prescribe the medication at the higher dose but document the conversation with the registrar and the reasons for prescribing the higher dose.
E) Ignore the situation and prescribe the medication at the lower dose that you believe is safe, without discussing the situation with the senior colleague.
B) Follow the registrar's instructions and prescribe the medication at the higher dose.

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You are working in a busy emergency room and a patient with a history of chronic pain management presents with severe pain. The patient claims they lost their medication and is requesting a refill of their opioids. You are unsure of the legitimacy of their claim.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Refuse to prescribe the opioids and recommend alternative treatments for pain management.
E) Provide the patient with a prescription for a higher dosage of opioids than what they are accustomed to in case they are lying about the lost medication.
B) Request additional information from the patient's previous provider before deciding.
C) Prescribe a lower dosage of opioids than what the patient is accustomed to.
D) Prescribe the opioids without hesitation as the patient appears to be in genuine pain.

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You are a doctor walking through a ward and hear a nurse verbally abusing an elderly patient with severe dementia. The tone and language used are unpleasant.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Contact the police anonymously to avoid raising the issue with employees of your hospital.
D) Use body language to show your disapproval but do nothing formally as patient safety is not at risk.
B) Discuss the situation with a Clinical Nurse Manager (CNM) in the first instance as soon as they arrive
C) Make preliminary enquiries from other staff working that night to ask if they have noticed inappropriate behaviour
A) Confront the nurse and separate them from the patient.

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You are a junior doctor who has been asked by a patient to keep a medical condition a secret from their family. The patient is worried about the impact that the disclosure may have on their family relationships. You are concerned about the patient’s safety and wellbeing, and you are also worried about the potential for harm to others if the condition is not disclosed.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Respect the patient's autonomy and maintain patient confidentiality, unless there is an immediate risk of harm to the patient or others.
C) Seek advice from a senior clinician or the hospital's ethics committee.
E) Discuss the situation with your colleagues and try to persuade the patient to disclose the condition to their family.
D) Contact the patient's family and disclose the condition, without the patient's consent, if you believe that there is a serious risk of harm to the patient or others.
A) Explain to the patient the potential harm of not disclosing the condition to their family, and the importance of informing the family.

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You are a doctor (NCHD) in a hospital with limited resources. You have two patients, one elderly man and one young woman, both in critical condition and in need of a ventilator. You only have one ventilator available. The hospital administration has instructed you to prioritise the younger patient due to the potential for a longer life expectancy. However, the older patient has a chance of survival with the ventilator too. You are struggling to decide what to do.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Consult with the hospital ethics committee or a senior medical staff member.
E) Try to find alternative options or resources to obtain another ventilator.
C) Provide the ventilator to the younger patient, following the hospital's instruction.
D) Provide the ventilator to the older patient, ignoring the hospital's instruction.
B) Speak with the hospital administration and explain your concerns.

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Your team is treating a patient who has been admitted with symptoms consistent with COVID-19. The patient tests positive for the virus and is immediately transferred to the isolation ward. You have been in close contact with the patient during the initial examination, and you are not vaccinated against COVID-19. You feel fine and show no symptoms, but you know that you should self-isolate for 10 days. However, you have MRCPI coming up, and missing it could jeopardise your career prospects.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Inform your supervisor about your situation and request advice on whether to self-isolate or attend the exam.
C) Try to reschedule the exam and then self-isolate for the required time.
A) Attend the exam and then self-isolate for the required time afterwards.
E) Attempt to conceal your situation and attend the exam as scheduled.
D) Decide to take the exam and continue working as normal, since you do not have any symptoms.

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You are working in a busy emergency room when a patient presents with severe chest pain and shortness of breath. The triage nurse has already ordered an electrocardiogram (ECG) and started the patient on oxygen therapy. As you review the ECG, you notice that the patient is having a heart attack. Which of the following actions would be most appropriate in this situation?

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Administer a thrombolytic agent to the patient to dissolve the clot causing the heart attack.
C). Consult with a cardiologist before initiating any treatment.
D) Administer aspirin to the patient to help prevent further clotting.
E) Perform further diagnostic tests before initiating any treatment.
A) Immediately activate the cardiac catheterization team to perform an emergency angiogram.

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You notice that a colleague is not performing clinical tasks appropriately and is not following correct procedures. You have raised your concerns with the colleague, but they have not changed their behaviour.

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

E) Speak to other colleagues about the situation and try to gather support for your concerns.
B) Report the colleague anonymously to the regulatory authority.
C) Confront the colleague in front of the team and demand an explanation.
A) Speak to your supervisor or the clinical lead to raise your concerns.
D) Ignore the situation and continue working normally.

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What should you do if your consultant suggests that you attend a one-day course in another city the following week, but you have no remaining annual leave days and are not entitled to study leave?

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Speak to your Educational Supervisor and, with their support, ask the service manager for special permission.
D) Add up the number of days that you worked late the week before and attend the course as you are owed enough hours in lieu.
E) Attend the course as you already have your consultant’s permission.
A) Ask your SHO if she will look after the ward in your absence and go if she agrees.
C) Accept that you cannot attend the course this time and book the next one.

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A patient with advanced dementia is admitted to the hospital with pneumonia. The family member who is the patient’s primary caregiver expresses concerns about the medical treatment the patient is receiving and believes the patient is not being adequately hydrated. They ask for your advice on what to do.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Explain to the family member the rationale for the medical treatment the patient is receiving.
D) Suggest the family member file a formal complaint with the hospital.
A) Tell the family member not to worry and that the medical team is doing their best.
E) Agree with the family member that the medical team is not providing adequate care and suggest they take legal action against the hospital.
B) Inform the medical team of the family member's concerns and ask them to address the hydration issue.

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You are working in a busy hospital emergency department and a patient arrives with a head injury. The patient is accompanied by a family member who is insisting that the patient be seen immediately and demanding that you skip other patients who have been waiting longer.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Ignore the family member and attend to other patients who have been waiting longer.
C) Assure the family member that the patient will be seen immediately and skip other patients who have been waiting longer.
A) Explain to the family member that the patient will be seen as soon as possible but that there are other patients with urgent needs who have been waiting longer.
D) Consult with a senior member of the medical team to determine the best course of action.
B) Politely ask the family member to wait in the waiting room and inform them that you will update them as soon as possible.

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A teenage girl comes to you requesting contraception without their parents’ knowledge. They confide that they are sexually active and feel uncomfortable discussing this with their parents.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Explain that as a minor, her parents have the legal right to be involved in their healthcare decisions and that you cannot provide contraception without their knowledge.
B) Discuss the importance of involving parents in her healthcare decisions and offer to speak with the parents together or separately.
A) Respect her privacy and provide with information about contraception and safer sex practices.
D) Contact her parents to inform them of their child's request for contraception and discuss the situation with them.
E) Refuse to provide contraception without her parents' knowledge and advise them to abstain from sexual activity until they feel comfortable involving parents in her healthcare decisions.

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You are examining a nine-month-old infant in the emergency department who has been brought in by their parents after an episode of severe vomiting. On examination, you find that the child has multiple piercings on their ears. The parents say that the piercings were performed by a professional piercer in accordance with their cultural beliefs.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Refer the parents to parenting classes for failing to act in accordance with their child's best interests.
A) The piercings do not require treatment on this admission, as they have nothing to do with the presenting complaint.
D) Refer the patient to a pediatric surgeon for further assessment.
B) Document the findings and discuss the management options with your consultant.
C) The examination finding constitutes evidence of child abuse, and Child Protection Services should be informed immediately.

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A patient with a history of alcohol abuse has been admitted to the hospital for acute pancreatitis. The patient is in severe pain and is requesting strong pain medication, but you notice that their medical chart indicates a history of opioid addiction.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Discuss the patient's pain management options with the care team and consider alternative pain management strategies.
C) Consult with a pain management specialist to develop a safe and effective pain management plan for the patient.
E) Disregard the patient's history of opioid addiction and prescribe the opioids as requested by the patient.
B) Inform the patient of their history of opioid addiction and explain why prescribing opioids may be problematic.
D) Prescribe the opioids as requested by the patient to manage their pain.

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A patient with a history of congestive heart failure has been prescribed a medication known to exacerbate the condition. The prescription was mistakenly entered into the electronic health record by a trainee doctor who was not familiar with the patient’s medical history.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Inform the nurse in charge of the patient to hold the medication until the prescribing doctor can be reached.
E) Alter the prescription to a lower dose and continue to monitor the patient for any adverse effects.
D) Document the incident in the patient's medical record and report it to the hospital's quality assurance department.
B) Check the patient's vital signs and assess whether they are experiencing any symptoms of heart failure.
A) Contact the prescribing doctor immediately to inform them of the mistake and advise them to stop the prescription.

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What actions should you take if you discover that a registrar has prescribed Tazocin, which contains a penicillin antibiotic, for Tim, a young male patient who has had a previous anaphylactic reaction to penicillin?

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Complete a clinical incident form.
A) Strike out the prescription and inform the nurse not to administer the medication.
D) Ensure that the patient's allergy is clearly documented on the drug chart and in their notes.
C) Speak with the registrar to alert him/her to the mistake.
E) Amend the prescription without making a fuss.

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You are a medical student on a placement in a busy hospital. During your shift, you witness a consultant speaking harshly to a 1st year GP-Trainee in front of other staff members. You can see that the junior doctor is visibly upset.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Report the incident anonymously to the hospital’s complaints department to avoid confrontation.
C) Speak to the consultant’s supervisor or manager about the incident
D) Do nothing as it is not your place to intervene in an argument between colleagues
B) Inform the junior doctor that you witnessed the incident and offer your support
A) Approach the consultant and ask to speak with them privately

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During a two-week vacation in Spain, you become involved in a heated argument at a restaurant and are subsequently given a caution by the local police. You return to work feeling upset and embarrassed but determined to put the entire incident behind you.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Attempt to move past the issue.
B) Wait until you have settled into your new rotation before addressing the matter.
E) Consult your supervising consultant for advice on how to proceed.
C) Inform your Medical Defence Union and seek legal counsel.
D) Contact the IMC (Irish Medical Council) immediately to report the caution.

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You receive your first pay-check as a qualified doctor at the end of a busy month working in a hectic emergency department. You are surprised to find that you have received payment for additional night shifts, despite not having worked those specific shifts. You calculate that the additional payment you have received is significantly more than the extra hours you have had to work in the emergency department.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Discuss the issue with your Educational Supervisor, as you should not be working outside your contracted hours.
C) Keep a work diary of the number of hours that you are working.
B) Donate 95% of the additional income to a charity of your choice, keeping a small amount as compensation for your efforts.
A) You believe you deserve the extra payment for the hard work you've done and decide to keep the money.
E) Alert payroll to the error so that any additional payment can be returned or adjusted from your salary.

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One of your junior colleagues on the team regularly takes home a copy of the patients’ investigations as there is no confidential waste bin available on the ward. He argues that this helps him prepare for the following day’s consultant ward round by allowing them to memorise the patient details in advance.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Take a copy of the patients' investigations home to be as well-informed as your colleague.
B) Discuss your colleague's behavior with the consultant.
C) Tell your colleague that it is unfair to know patient details before the ward round, and it makes you look disorganised.
A) Explain to your colleague that they should not be taking patients' investigations home every day.
E) Inquire with a Clinical Nurse Manager (CNM) about getting a confidential waste bin on the ward

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During a two-week vacation in Australia, you become involved in a heated argument at a restaurant and subsequently receive a caution from the police. You return to work feeling upset and embarrassed, but determined to move on from the incident.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Inform your Medical Defence Organisation and seek legal advice.
D) Contact the IMC (Irish Medical Council) immediately to report the caution.
A) Try to put the issue behind you.
B) Wait until you have settled into your new rotation before raising the issue.
E) Ask your consultant for advice on how you should proceed.

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You arrive at work before the consultant ward round and attempt to prepare the patient list. You are hindered by a slow computer and a malfunctioning printer. The ward round cannot begin until you have an updated patient list, and your consultant is growing impatient as they need to start an all-day surgery list.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Ask a medical student to prepare the list while you begin the ward round.
D) Inquire with the nurses on each of the wards if there are any new patients under your consultant's care.
E) Suggest the team reconvene in 15 minutes while you contact the IT helpdesk and attempt to prepare the list.
B) Send the patient list to your personal email address and print it on a nearby ward.
A) Voice your frustration with the IT equipment and insist that the consultant requests replacements.

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During a train journey back from a weekend in Galway, an announcement is made requesting medical assistance for one of the passengers. You graduated from medical school three weeks ago and have yet to start your first job as an intern; you feel particularly apprehensive about attending to a possible on-train emergency on your own.

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

A) Do nothing since you are not legally bound to provide medical assistance as you have not yet signed a contract with your employer.
E) Review the passenger, but ask the train staff to make an announcement for more senior medical assistance as you are only recently qualified and very inexperienced.
D) Wait for ten minutes to see if anyone else on board can assist before volunteering to assess the passenger.
B) Inform the train staff that you are a recently qualified doctor, and begin your medical assessment immediately.
C) Approach the unwell passenger and determine if you will be able to offer any help before informing the train staff of your presence.

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While on your break, you witness a 1st year GP-Trainee colleague arguing with a pharmacist in front of a patient. Later, the pharmacist approaches you to discuss the doctor’s behavior. They mention that the doctor has had several confrontational incidents since joining the ward two months ago and is unsure how to handle the situation.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Send an email to your trainee colleague detailing what the pharmacist has told you, to provide a written record of your conversation.
C) Apologize on behalf of the trainee, and ask the pharmacist not to pursue the matter any further at this time as you will speak to the other doctor.
D) Inform the trainee colleague's Clinical Supervisor about the incident and what the pharmacist has told you.
B) Contact the trainee and ask them to return to the ward and apologize to the pharmacist and patient.
A) Suggest the pharmacist speak with their line manager as it is not your responsibility to get involved in pharmacy-related matters.

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You notice a fellow intern berating a healthcare assistant in front of a patient. Afterward, the healthcare assistant approaches you to discuss the intern’s behavior. They explain that the intern has had several ‘angry outbursts’ since joining the ward two months ago, and they are unsure how to address the situation.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Send an email to your intern colleague detailing what the healthcare assistant has told you, to provide a written record of your conversation.
D) Inform the intern's Educational Supervisor about the incident and what the healthcare assistant has told you.
A) Advise the healthcare assistant to speak with their line manager, as it is not your responsibility to get involved in matters unrelated to your role.
B) Call the intern and ask them to return to the ward and apologize to the healthcare assistant and patient.
C) Apologize on behalf of the intern and ask the healthcare assistant not to pursue the matter any further at this time, as you will speak to the other doctor.

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During a bus journey back from a conference in Dublin, an announcement is made requesting medical assistance for one of the passengers. You graduated from medical school three weeks ago and have yet to start your first job as an intern; you feel particularly apprehensive about attending to a possible on-bus emergency on your own.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Inform the bus staff that you are a recently qualified doctor, and begin your medical assessment immediately.
E) Review the passenger, but ask the bus staff to make an announcement for more senior medical assistance as you are only recently qualified and very inexperienced.
B) Do nothing since you are not legally bound to provide medical assistance as you have not yet signed a contract with your employer.
A) Wait for ten minutes to see if anyone else on board can assist before volunteering to assess the passenger.
D) Approach the unwell passenger and determine if you will be able to offer any help before informing the bus staff of your presence.

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During a lunch break, a group of medical students ask if you can help them prepare for their upcoming end-of-module examination on the cardiovascular system. You agree to teach them at the end of the week, provided that they assist you with some administrative tasks that evening, which they agree to do. You are reminded about your teaching commitment the day before the students’ examination, but unfortunately, you have forgotten to prepare a relevant lesson plan.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Teach the students about gastroenterology, with which you are more comfortable.
E) Attempt to teach the students, even if your knowledge is insufficient, but finish the teaching early if it does not prove helpful.
B) Inform the students that they should have reminded you earlier in the week, and now you are unable to teach them.
D) Utilize a teaching style that focuses on questioning the students and reflecting every question asked back towards the group.
C) Postpone the teaching until they want to prepare for their next end-of-module examination.

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During a lunch break, a group of medical students ask if you can help them prepare for their upcoming end-of-module examination on the renal system. You agree to teach them at the end of the week, provided that they assist you with some paperwork tasks that evening, which they agree to do. You are reminded about your teaching commitment the day before the students’ examination, but unfortunately, you have forgotten to prepare a relevant lesson plan.

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

A) Teach the students about immunology, with which you are more comfortable.
C) Postpone the teaching until they want to prepare for their next end-of-module examination.
B) Inform the students that they should have reminded you earlier in the week, and now you are unable to teach them.
E) Attempt to teach the students, even if your knowledge is insufficient, but finish the teaching early if it does not prove helpful.
D) Utilize a teaching style that focuses on questioning the students and reflecting every question asked back towards the group.

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You are an intern with a strong interest in cardiology. To enhance your application for a specialty training program, you desire to complete an Advanced Cardiac Life Support (ACLS) course. However, your hospital gives priority to doctors working in Intensive Care Units (ICU). One of the ICU doctors, who secured a spot based on their current role, offers you the course spot in exchange for covering one of their on-call shifts.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Agree to the arrangement, as it seems to be mutually beneficial.
D) Accept the offer and participate in the course, but fail to show up for the on-call shift.
A) Reject the proposal outright.
B) Inform the ICU doctor that you appreciate the offer but are unwilling to cover the on-call shift.
E) Seek counsel from the ACLS coordinator at your hospital.

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A female SHO colleague in cardiology is clerking a nervous 16-year-old boy who has been brought into A&E by his mother, claiming that he has been experiencing chest pain after being assaulted. After establishing a good rapport with the patient, the SHO arranges for a physical examination. However, the boy remains adamant that no one else be present. In the absence of your registrar, your fellow SHO asks for your advice.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Advise her not to examine the patient and instead wait for the registrar.
A) She should agree to forego the chaperone and complete a thorough physical and internal examination to rule out any injury.
D) Ask the boy's mother to sign in the medical notes agreeing to act as the chaperone.
C) Suggest that she performs a physical examination by inspection alone, with a chaperone present if the boy agrees.
E) Tell her to insist on the presence of a male nurse as a chaperone and to avoid examining the patient if he insists on no one else being present.

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Your hospital has recently been in the headlines due to a confidential report revealing an increase in postoperative complications following laparoscopic surgeries. As a junior doctor in the general surgery department, you strongly believe that the media’s portrayal of your senior colleagues is unjust, attributing the complication rates to the recent transition to a new type of surgical equipment. As you are leaving the hospital, a reporter approaches you for a comment on the situation.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Respectfully decline to provide a comment.
E) Express your irritation about the lack of understanding shown by the media and the general public regarding the intricacies of healthcare and medical practice.
B) Obtain the reporter's contact information and agree to an interview once you've obtained approval from your hospital's administration.
A) Discuss openly with the reporter your views on the competence of your senior colleagues and the possibility of the new surgical equipment being at fault.
D) In broad terms, talk about the hurdles faced by medical practitioners when new surgical techniques or equipment are introduced, without referring specifically to your department.

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A final-year medical student on your ward asks you to write a reference in support of their application for a part-time photography course, which starts two months before their final-year examinations. You are concerned because, despite their enthusiasm, the student has a poor clinical knowledge base. You are not convinced by their assurances that they will be able to balance this new commitment with their medical course.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Write a supportive reference, as their clinical knowledge base is not relevant to their performance in a photography course.
C) Suggest that they ask your consultant to write a reference to provide a more experienced perspective on their ability.
B) Write a reference indicating that their clinical knowledge base is poor but that they might do much better in a different subject.
E) Tell the student that your position might not qualify you to comment on their suitability for the course.
D) Set the student a mock clinical examination and offer to write their reference based on their performance.

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39.As a junior doctor in neurology, you are responsible for looking after your consultant’s patients. One of the patients who had been under your care for the last 48 hours is transferred to the premium care unit on the other side of the hospital. At the request of your consultant, the nurses in the premium care unit have paged you on several occasions to perform various clinical procedures. You feel overwhelmed by the extra workload and are unsure whether you will be able to complete your regular tasks.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Share your concerns with one of the other neurology consultants.
A) Ignore any pages from the premium care unit; if the consultant really needs you, they will contact you directly.
B) Ask the consultant for additional compensation in return for spending more time assisting with their premium care patients.
D) Speak to the patient and ask whether they would mind returning to the standard ward.
E) Schedule a meeting with the neurology consultant, via their secretary, to discuss the increased workload.

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As a junior doctor in the paediatrics department, you are tasked with administering vaccinations to several patients. A fellow doctor who works alongside you is asked to vaccinate a patient they’ve been taking care of. However, the doctor has a conscientious objection to vaccinations, based on personal beliefs, and would prefer if you could administer the vaccine even though you have not personally treated the patient.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Refuse to administer the vaccine on the grounds that you are not familiar with the patient.
A) Consent to administer the vaccination as your colleague has provided a valid reason for refusing.
D) Propose that they take a few days of annual leave, which will provide time for the department to find someone else to administer the vaccine.
B) Suggest to your colleague that they claim to lack the necessary training to administer vaccines.
C) Remind your colleague that they have a duty to put aside any personal beliefs and administer the vaccine.

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As a BST-Trainee doctor with an interest in paediatrics, you wish to improve your higher specialty training (HST) application by completing a Pediatric Advanced Life Support (PALS) course. Regrettably, your hospital gives precedence to doctors working in the Neonatal Intensive Care Unit (NICU). A NICU doctor, who has been allotted a place based on this policy, offers it to you if you agree to cover one of her night shifts.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Consult with the PALS coordinator at your hospital for guidance.
A) Accept her offer as it seems to be an agreement that benefits both parties.
C) Decline the offer.
E) Accept her offer and attend the course, but fail to show up for the night shift.
B) Inform the other foundation doctor that you are grateful for her offer, but you are unwilling to cover the night shift.

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You are a BST-Medicine trainee with an interest in gastroenterology. In an effort to enhance your specialty training application, you are keen on completing an Endoscopy Training Course. However, your hospital allocates priority for this course to doctors working in the surgical department. One of the surgical doctors, who has secured a place due to this arrangement, offers you his spot in exchange for you covering a few of his on-call duties.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Accept the offer as it could potentially benefit both of you.
D) Consult with the coordinator of the Endoscopy Training Course at your hospital.
B) Inform the surgical doctor that you gratefully accept his offer but you are not prepared to cover his on-call duties.
C) Decline the offer outright.
E) Agree to his proposal and attend the course, but don't fulfill your promise to cover his on-call duties.

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As a doctor in a hospital, you are asked by a senior consultant to prescribe a medication to a patient that you believe to be unnecessary and potentially harmful. The consultant is insistent that you write the prescription, and you are aware that they hold significant power within the hospital.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Prescribe the medication as requested, to avoid potential repercussions.
C) Raise your concerns with the consultant, explaining your position and reasons for not wanting to prescribe the medication.
B) Refuse to prescribe the medication, citing your concerns about its necessity and potential harm.
D) Consult with another senior consultant or hospital administrator about the situation and how to proceed.
E) Contact a medical ethics advisor or professional body for guidance on how to handle the situation.

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You are a new SHO-1 doctor on a gastroenterology team. The morning ward round is running late, and both your consultant and registrar need to attend a critical procedure. One patient has yet to be consented for an endoscopic retrograde cholangiopancreatography (ERCP) following the diagnosis of a common bile duct stone. Your registrar tells you to make sure that the patient is consented in time to be second on the morning list.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Ask an SHO from another team who can perform ERCPs to take consent.
A) Consent the patient before addressing any other tasks.
B) Complete all urgent tasks arising from the ward round, and then consent the patient.
E) Agree to consent the patient and then ask experienced nurses to show you how to do this correctly.
C) Explain that you do not have sufficient experience to consent patients for this procedure.

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As a newly minted SHO-1 in the gastroenterology department, you find yourself in the middle of a hectic morning ward round. Both your consultant and the senior registrar need to leave for a scheduled endoscopy list. There’s one patient who hasn’t yet given his consent for a colonoscopy after presenting with alarming GI symptoms. Your senior registrar instructs you to make sure the patient’s consent is obtained in time to be included on the morning list.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Ask an SHO-1 from another team, who routinely performs colonoscopies, to take the patient's consent.
C) Express that you don't feel adequately trained to take consent for this procedure.
A) Consent the patient immediately, putting off other tasks.
E) Agree to consent the patient and then seek guidance from experienced nurses on how to correctly do this.
B) Address all pressing tasks resulting from the ward round first, and then consent the patient.

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As the junior doctor in neurology, you are responsible for looking after your consultant’s public patients. One of the patients who had been under your care for the last 48 hours is transferred to a private clinic outside of the hospital. At the request of your consultant, the nurses at the private clinic have paged you several times to complete various clinical procedures. You find the additional workload challenging and are uncertain whether you will be able to complete your routine tasks.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Ignore any pages from the private clinic; if it's truly a request from the consultant, he will reach out directly to you.
D) Schedule a meeting with the neurology consultant, via his secretary, to discuss the additional workload.
A) Seek additional compensation from the consultant in exchange for your extra time assisting with his private patients.
B) Discuss the situation with one of the other neurology consultants.
C) Converse with the patient and ask if they would consider returning to the public ward.

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You are the SHO-1 doctor on call for general surgery. After examining a patient with appendicitis, you realize the need to insert a central venous line (CVL). Unfortunately, your only hands-on experience of this procedure was during a skills lab session two years ago. You’ve never attempted to perform a CVL insertion on a patient before and are feeling unsure about your success.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Contact the on-call surgical registrar and ask them to supervise your first CVL insertion.
B) Ask another SHO-1 doctor who is more experienced and comfortable with procedures to assist you.
E) Attempt the procedure twice after discussing it with the patient, and then seek help if unsuccessful.
D) Wait until your shift ends and then hand the task over to the night team.
C) Try the procedure but without informing the patient about your lack of experience.

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As an SHO-1 doctor on a hectic medical ward round, your consultant instructs you to request an urgent MRI scan to be completed that day. Despite jotting this down on your task list, you’re uncertain about the necessity of this scan.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Inquire with the consultant about the purpose of the scan.
C) Share your reservations with the consultant and express your discomfort in ordering the scan.
D) Seek a fellow team member's explanation as to why the MRI scan is required.
B) Inform the duty radiologist that you're unsure about the need for the scan but have been ordered to request it.
E) Schedule a CT scan instead, and then reevaluate the necessity of the MRI scan based on its results.

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You are an SHO-1 doctor on call for neurology. After examining a patient with a severe headache, you realize the need for a lumbar puncture (LP). Unfortunately, your only experience of this procedure was on a simulator three years ago during medical school. You have never attempted to perform an LP on a patient before and are feeling unsure about your ability.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Contact the on-call neurology consultant and request supervision for your first LP.
C) Undertake the procedure, but without informing the patient about your lack of experience.
E) Make an attempt at the procedure after discussing it with the patient, and then seek help if unsuccessful.
B) Request assistance from another SHO-1 who is present and more comfortable with the procedure.
D) Delay until the end of your shift and then pass the task to the incoming on-call team.

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As an SHO-1 doctor on call, you are notified by the biochemistry lab about a critical lab result. The value they give you indicates severe hypokalaemia. You do not remember much about the management of hypokalaemia and have never managed a patient with this condition before.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Prescribe a beta blocker such as propranolol.
C) Use a search engine like Google to look up 'hypokalaemia' for guidance.
D) Refer to hospital protocols, either online or in hard copy.
B) Evaluate the patient to ensure their stability, and then call the on-call medical consultant.
A) Contact the on-call medical consultant and ask for advice.

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As an SHO-1 doctor on call, you receive a call from the laboratory about an abnormally high potassium level in a patient’s blood results, indicating severe hyperkalaemia. Your memory on the management of hyperkalaemia is a bit foggy and you have never managed a patient with this condition before.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Search for 'hyperkalaemia' on the internet to refresh your memory.
A) Contact the on-call medical consultant and ask for advice.
D) Look up hospital guidelines or protocols, either in hard copy or online.
B) Immediately go to assess the patient's wellbeing, then call the on-call medical consultant.
E) Prescribe a beta-blocker like atenolol.

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You’re an SHO-1 on a busy internal medicine round. Your consultant instructs you to order an urgent MRI scan and make sure it’s performed that afternoon. Although you take note of this on your tasks list, you’re uncertain about the justification for the scan.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Ask the consultant why the scan is required.
B) Inform the duty radiologist that you question the necessity of the scan but were instructed that it's urgent.
D) Ask a colleague in your team to explain why the MRI scan is necessary.
C) Explain to your consultant that you're unable to order the scan as you're unsure of its appropriateness.
E) Schedule a CT scan instead, and then reconsider the MRI scan later based on its findings.

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As an SHO-1 doctor, your Ward Sister brings up an issue about a medication you prescribed erroneously. You prescribed a dose ten times higher than recommended, which was fortunately noticed by an alert pharmacist and never administered. However, a clinical incident report has been filed, and the Ward Sister plans to inform your Clinical Supervisor. You believe your fatigue contributed to this mistake.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Request a meeting with your Clinical Supervisor to discuss the error and your concerns about the shift rotation.
C) Request the Ward Sister not to contact your Clinical Supervisor as it was a one-off mistake.
D) Use your e-portfolio to document the mistake and reflect on its causes to prevent it from recurring.
B) Own up to the mistake but clarify the factors that may have led to the error.
A) Tell the Ward Sister that it wasn't your fault because the hospital forced you to work exhausting shifts.

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You are at a family gathering when you recall that you ordered a blood test for a patient in a critical condition, but you forgot to check the result or delegate the task before leaving.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Reflect on this oversight and plan to devise a system to prevent such a lapse in the future.
E) Drive back to the hospital immediately to check the result yourself.
B) Contact the on-call SHO-1 doctor and request them to check the result.
C) Ignore the issue for now, emphasizing the importance of work-life balance.
A) Make a mental note to check the result first thing when your shift starts again.

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As a junior doctor, you’ve been told by a close colleague that you seem constantly irritated and have been for the past several weeks. While you acknowledge that you’re not your usual self, you attribute it to the high-stress environment and lack of rest. However, the suggestion from your colleague that you might be dealing with burnout has left you feeling uncomfortable.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Engage in a discussion with your colleague to understand their observation and concern.
B) Schedule an appointment with your Occupational Health department to talk about your mental wellbeing.
C) Make an appointment with your GP for a check-up.
D) Ask other colleagues if they've observed similar changes in your behavior.
E) Use a burnout self-assessment tool online to evaluate your current state.

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You are the junior doctor on call for surgery. A nursing colleague points out that you seem unusually ‘stressed’ and have been for a few weeks. You acknowledge you’ve been feeling more overwhelmed than usual but attribute it to the work pressure and fatigue. You are embarrassed by your colleague’s observation and do not believe you are suffering from burnout.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Arrange a routine consultation with your GP.
A) Discuss with your colleague about the specifics of their concerns.
B) Schedule an appointment with your Educational Supervisor to discuss your emotional wellbeing.
E) Use a burnout self-assessment tool to ascertain whether you require professional help.
D) Ask other surgical colleagues whether they think you're experiencing burnout.

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You are a medical student on a surgical rotation. One of the surgical SHO makes a derogatory comment about a patient who is currently on the operating table under anaesthesia. The comment is offensive and discriminatory.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Report the surgical SHO to the hospital administration immediately.
C) Confront the surgical SHO in front of other staff and let them know that their comment was offensive.
D) Ignore the situation and focus on the surgery.
B) Speak to the attending surgeon in private and let them know what you overheard.
A) Speak to the surgical SHO privately and let them know that their comment was inappropriate.

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You are enjoying a day off and have gone hiking. During the hike, you recall ordering a crucial lab test for a patient showing worrying symptoms, but you forgot to follow up or hand over this task.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Call the on-duty SHO doctor through the hospital switchboard and ask them to check the result.
C) Try to forget about it—after all, everyone needs downtime.
A) Make a mental note to check the test result first thing on your next shift.
E) Drive back to the hospital to check the result yourself.
D) Reflect on this oversight and commit to establishing a system to avoid such errors in the future.

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During a ward round, a patient recovering from a cholecystectomy asks you whether he’ll have to modify his diet permanently after the surgery. You remember that diet adjustments might be necessary but aren’t entirely sure about the specifics.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Propose to ask your registrar to speak with the patient later for more precise advice.
B) Let the patient know that as a junior doctor, you're not equipped to provide detailed dietary advice.
C) Clarify that diet changes may be necessary post-cholecystectomy and that you'll seek more specific information for his case.
A) Inform the patient that he will need to modify his diet.
E) Allocate some time to research about diet post-cholecystectomy so you can respond to similar queries more effectively in the future.

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During a late-night shift, you are monitoring a patient who has had a severe asthma attack. Despite administering nebulisers and corticosteroids, the patient’s oxygen levels continue to fall, and they are increasingly struggling to breathe. Even though you are a junior doctor, you’ve recently completed an Advanced Life Support (ALS) course and are confident in your ability to manage acutely unwell patients.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Persist in managing the patient, irrespective of their worsening condition.
C) Reach out to the consultant directly via mobile phone.
E) Continue caring for the patient, unless their condition deteriorates further.
D) Call the on-call registrar for advice.
A) Alert the Critical Care team.

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You are examining a critically ill patient in the emergency department. She is complaining of severe abdominal pain and shows signs of hypotension, even after fluid therapy. Over the past few minutes, her mental status has started to deteriorate. Although you are an junior doctor, you’ve recently undergone training in Advanced Trauma Life Support (ATLS) and feel capable of managing critically ill patients.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Continue treatment unless her condition further deteriorates.
C) Contact the emergency department consultant directly.
D) Reach out to the senior house officer (SHO) for advice.
A) Activate the trauma team.
B) Continue to provide care for the patient regardless of her clinical deterioration.

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You are called into your supervisor’s office, who expresses concerns about your performance. Specifically, they mention your occasional tardiness for ward rounds and that your clinical knowledge is not at the level they expect for a doctor at your stage. You disagree with this assessment, as you have only been late a few times, and you believe your clinical knowledge is up to standard.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Seek advice from your medical training program about the possibility of switching supervisors due to the perceived communication gap.
D) Conduct a peer-review assessment using your e-portfolio to gather feedback about your performance from other colleagues.
A) Discuss your perspective with the supervisor and request for specific examples to justify their concerns.
E) Tell your supervisor that you consider your knowledge to be on par with other doctors at your level and that you were a high-achieving student in medical school.
C) Ask your supervisor for guidance on how you can address their concerns and improve your performance.

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You are called into the office by your clinical supervisor. She expresses concerns about your performance, specifically mentioning your occasional tardiness for rounds and your level of clinical knowledge, which she finds unsatisfactory for a doctor at your stage. However, you disagree with her assessment as you recall being late only a couple of times and you feel confident about your knowledge base.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Point out to the supervisor that you believe your knowledge is comparable to that of your peers and mention your academic achievements in medical school.
C) Seek advice from the supervisor on how to address her concerns and improve your performance.
D) Through your training portfolio, conduct a peer assessment survey seeking feedback about your performance from other trainees.
B) Inquire with the training program about the possibility of changing supervisor due to a perceived breakdown in communication.
A) Express your perspective respectfully, and ask her to provide concrete examples of her concerns.

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As the on-call first-year GP-Trainee, your shift is supposed to end at 9 p.m., and then you should hand over to the incoming night doctor. However, one particular night doctor consistently refuses to take on tasks that they believe should have been finished during your shift. As a result, you often find yourself leaving at midnight whenever this doctor is on the night shift.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Stay late if necessary to ensure that patient safety is not compromised.
B) Discuss the issue with a relevant authority (e.g., Training Supervisor) as a priority the next day.
E) Tell the night doctor that you have completed as many tasks as you could, and they should assume responsibility for the remaining tasks at the end of your shift.
C) Document that the night doctor refused to accept a handover and then go home.
A) Report the night doctor to the IMC.

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As a surgical SHO, you are expected to prepare ahead for the morning ward round at 7:30 a.m. However, your Clinical Supervisor insists that you also attend the 8 p.m. evening ward round. These hours contradict your contractual work hours, which are from 9 a.m. to 5 p.m.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Seek advice from your Educational Supervisor.
A) Acknowledge that long work hours are part and parcel of any surgical role.
B) Disregard your supervisor's directions and work from 9 a.m. to 5 p.m., as your contract dictates.
E) Tell your supervisor that you are contracted to work from 9 a.m. to 5 p.m.
D) Sneak home for a few hours every day to comply with the Working Time Directive.

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As a trainee doctor, your registrar asks you to perform a lumbar puncture on a patient. You’ve never done this procedure before, but your registrar insists it’s easy and no one else can help until the evening ward round, seven hours away.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Seek assistance from another doctor who has relevant experience.
D) Refuse to help because you're swamped with other ward duties.
B) Proceed but make sure to document you were following your registrar's instructions.
E) Study the procedure before attempting it.
C) Politely explain you can't safely perform the procedure and need supervision.

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After a major cardiac procedure, a patient ends up with an implantable cardioverter defibrillator (ICD). You are the first doctor to see the patient once they regain consciousness, and they ask whether the ICD is a temporary solution. You are certain that ICDs are generally permanent, but you don’t remember much else about it.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Tell the patient that the ICD will be there for life.
D) Offer to ask your registrar to visit later to answer specific questions.
E) Set aside time to study about ICDs so you can answer questions more thoroughly next time.
C) Explain that ICDs are typically permanent, but you will help to find out the specific plan in their case.
B) Explain that you are a junior doctor and don't have the expertise to answer complex cardiac queries.

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An elderly patient with severe heart failure is not improving despite optimal medical treatment. As the on-call cardiology SHO, you consider discussing the option of heart transplantation with the consultant cardiologist. However, the nursing staff and the patient’s family are convinced that the patient’s quality of life would not improve significantly and are advocating for comfort care measures only. You feel alone in your aggressive treatment approach.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Thoroughly familiarize yourself with the case and try to understand why the family and nursing staff want to opt for comfort care only.
B) Stop all active treatment to ease the patient's suffering and hasten his death.
D) Tell the patient's family to carefully consider the options and that you will respect their wishes if they all agree.
A) Ignore others and stick to your plan.
C) Contact a senior doctor to discuss the situation and ask for their opinion.

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A ward nurse contacts you while you’re on call about a unit of platelets that was accidentally removed from the fridge. As it cannot be put back, she requests you to prescribe it to a patient to avoid waste. You won’t be visiting the ward for a while and the nurse is anxious as the platelets will be unusable 30 minutes after refrigeration.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Scold her for unnecessarily removing the bag and plan to fill out a clinical incident report after your shift.
D) Clarify that transfusion is associated with substantial risks and that there's no need to transfuse a non-thrombocytopenic patient.
E) Suggest that she put the bag back into the refrigerator so it can be used by other patients.
A) Mention clearly that transfusion should not be performed just to prevent waste
C) Drive to the ward as soon as possible to prescribe the platelets.

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You’re a junior doctor working in a pediatric ward. A couple brings in their 5-year-old son who has a serious congenital heart condition. They feel your consultant has not thoroughly explained the benefits of a risky, but potentially life-saving surgery, and they’re considering refusing the procedure.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Defend your consultant's experience and wisdom, explaining that the consultant would only recommend a procedure if it's in the best interest of the patient.
A) Empathize with the parents' concerns and offer to have a meeting with them and the consultant to further discuss the matter.
C) Listen to the parents' worries and ask for more details about what exactly they don't understand or are concerned about.
D) Tell the parents that you can arrange for a second opinion from another specialist in pediatric cardiology.
E) Suggest that the family might want to consult with their religious or spiritual advisor about the ethical implications of refusing treatment for their child.

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You are SHO, and during your night shift, you’re called to the room of a patient who is exhibiting symptoms of a severe allergic reaction. Despite several senior doctors being present, nobody seems to have administered adrenaline, a first-line treatment.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Stay quiet, assuming the seniors are making the right decisions.
A) Assist with the patient's other symptoms that you're more comfortable managing.
E) Ask if an allergist or immunologist is present or en-route.
B) Ask the senior doctor why adrenaline hasn't been administered yet.
C) Prepare and administer adrenaline as per the protocol.

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You are a doctor on call and receive numerous requests from different parts of the hospital at the same time. You need to decide which one to attend to first, and in what order of priority.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C A 30-year-old woman post gynecological surgery who needs discharge summary and prescription before leaving.
D) A 50-year-old man with chronic kidney disease experiencing a flare-up of pain and needing analgesic review.
A) An upset son who is dissatisfied with his father's care and wants to discuss the issue.
B) A 75-year-old man with chronic obstructive pulmonary disease who suddenly develops difficulty breathing and becomes cyanotic.
E) A 38-year-old woman who is experiencing severe abdominal pain.

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You’re a SHO in a busy clinic. A teenager comes in with a suspected STI, requesting treatment. The teenager’s parents, who are unaware of the sexual activity, come to you asking for details about their child’s condition. The teenager has asked you not to disclose any information to the parents.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Politely explain to the parents that you cannot provide information without the teenager's consent.
C) Give the teenager the required treatment, knowing that the parents might find out later on.
E) Assure the teenager that under no circumstances would you disclose any information without their consent.
B) Discuss with a senior physician if the parents insist on knowing.
D) Tell the parents about the teenager's condition, as this could potentially benefit the family dynamic.

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You are an SHO in gastroenterology and have performed several colonoscopies before. A patient on your ward is scheduled for a colonoscopy, and you are asked to obtain consent. However, you remember that consent can be found invalid if the patient isn’t warned about significant complications.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Obtain verbal consent with a nurse as a witness.
A) Obtain verbal consent and document that the patient has been consented in the notes.
B) Obtain legal advice before consenting.
E) Refuse to perform the procedure as only registrar or above should consent.
D) Complete a formal written consent form.

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You are an on-call junior doctor in a district general hospital. The nurse from a nearby nursing home calls and explains that one of their residents, a 95-year-old man with advanced dementia, appears acutely unwell and they suspect he might have a chest infection. They have contacted his family’s private doctor who told them to reach out to the on-call doctor for assessment and possible hospital transfer.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Assess the patient but charge the nursing home for your services.
C) Agree to help if you are able, but let the nurse know that they should have a protocol for such situations.
B) Evaluate the urgency of the situation, based on the information given, and prioritize according to your other tasks.
A) Decline to assess the patient as he is not directly under your care and suggest that the private doctor attends to him.
E) Contact a responsible person (e.g. the duty manager) to clarify about your role in such cases.

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A nurse from a busy ward approaches you, a junior doctor, to sign off on a dosage of morphine she administered an hour ago to a patient in significant pain. Due to the high level of activity in the ward, she took this action and now insists this kind of practice is typical because of staffing issues.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Explain that an authorized prescriber must agree before drugs are given in the future.
A) Advise that a note should be made on the prescription chart and hospital notes to indicate the drug was administered.
E) Tell both nurses that only doctors have the required training to decide which drugs to prescribe.
B) Check the drug details to ensure that there were no contraindications and that an appropriate dose was administered.
D) Sign the prescription retrospectively.

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You are working in the paediatric department and are approached by a parent who is desperate to understand the specifics of their child’s rare genetic disorder. You’ve never encountered this condition before and the primary paediatrician is not available over the weekend. The parent seems to be very worried and distraught.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Ask the nurse to go through the medical records and provide an explanation to the parent.
C) Gather as much information about the genetic disorder from reliable medical sources and provide the parent with a simplified explanation.
B) Explain that you do not have detailed knowledge about the disorder and recommend they consult with the primary paediatrician.
E) Politely decline to discuss the child's condition until the primary paediatrician is available.
D) Listen to the parent's concerns, reassure them, and promise to arrange a meeting with the primary paediatrician at the earliest.

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You are BST-Medicine Trainee doctor working in a hospital. One of your patients is a terminally ill cancer patient who is in a lot of pain. The patient has requested a higher dose of painkillers than you are comfortable prescribing. You are worried that the higher dose could lead to respiratory depression and hasten the patient’s death.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Refuse to prescribe the higher dose of painkillers and explain the risks to the patient.
B) Consult with the senior doctor or pain management specialist in charge of the patient's care.
E) Delay the decision and continue with the current dose of painkillers.
C) Follow the patient's wishes and prescribe the higher dose of painkillers.
A) Discuss the situation with the patient's family members and ask for their opinion.

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You are working as a junior doctor at night in the emergency department when you are asked to clerk a patient who is unable to speak English and there are no available interpreters on hand.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Ask the patient to write down their symptoms and use an online translation tool.
E) Make an educated guess based on the patient's non-verbal cues and limited communication.
A) Use a translation app on your phone to communicate with the patient.
B) Proceed with a physical examination and base your diagnosis on the findings.
C) Wait until an interpreter can be present before attempting to clerk the patient.

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You are a junior doctor working in a geriatric ward. A patient with limited English proficiency is admitted under your care. Her granddaughter, who speaks fluent English, is accompanying her. As you start to take the patient’s history, you suspect that the granddaughter is omitting important pieces of information during translation.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Arrange another appointment with a professional interpreter.
B) Ask the granddaughter to leave and attempt to communicate with the patient without an interpreter.
E) Determine whether the patient is comfortable with her granddaughter acting as the interpreter.
C) Politely ask the granddaughter to translate the patient's words as accurately as possible.
D) Request assistance from a fellow staff member who speaks the same language as the patient.

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You are working as a junior doctor in the emergency department when a patient arrives with chest pain. The patient’s symptoms suggest a possible heart attack. You are asked to call the on-call cardiologist to discuss an urgent coronary angiogram. Amidst the chaos of the ED, you forget and remember to call the cardiologist 45 minutes later.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Call your own consultant and ask for advice first.
B) Inform your senior about the delay and call the cardiologist immediately to discuss the angiogram.
C) Call the cardiologist and say that the senior doctor only just asked you to arrange the angiogram.
E) Ask your senior to call the cardiologist directly.
D) Call the cardiologist and explain that the senior doctor wants the angiogram but you think it's likely to be angina.

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You are a Senior House Officer in the geriatric ward and are about to finish your shift when a new patient with dementia is admitted. The patient’s caregiver provides a list of several daily tasks necessary for the patient’s care. However, the patient seems agitated and confused.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Ask the nurses to attend to the patient and deal with the tasks while you finish your remaining work.
E) Try to complete all the tasks yourself before leaving.
A) Suggest the caregiver to stay and assist the patient until the night shift team arrives.
D) Prioritize tasks based on their immediate importance and complete those before handing over to the next shift.
B) Leave and delegate the tasks to the night shift team.

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You are SHO in gastroenterology taking care of a patient who is scheduled for discharge later today. During the patient’s stay, an abdominal CT scan was performed due to unexplained weight loss. While the scan didn’t find a specific cause for the weight loss, it did reveal a kidney mass of unknown significance, with a recommendation for follow-up imaging.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Inform the ward clerk to communicate the report findings to the patient.
E) Recommend that the patient return to the gastroenterology clinic to see your consultant for further evaluation of the mass.
A) Highlight the incidental finding and the need for a follow-up scan in the discharge letter using capital letters.
C) Discuss the issue with the patient and make sure he understand they need to see his GP to schedule a follow-up CT scan.
B) Personally call the patient's GP to inform them about this finding.

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You are the research associate for a clinical trial studying a new antihypertensive medication. A patient with long-standing hypertension and anxiety is scheduled for a regular clinic visit. This patient’s medical history makes her a good candidate for the study, but she is known to have severe anxiety related to medical procedures and changes in her treatment.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Do not include the patient in the study due to her level of anxiety.
A) Since she is already anxious, briefly explain the clinical trial and ask her to sign the consent form without going into details.
B) Explain the potential benefits and risks of the new antihypertensive medication, emphasizing that her total risk from the procedure would not significantly increase.
C) Try to alleviate her anxiety by explaining that her participation in the trial could lead to the development of more effective antihypertensive treatments.
D) Proceed with enrolling her into the clinical trial, but wait until after her regular clinic visit to obtain consent for her participation.

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You’re part of a medical team handling a COVID-19 ward. Another medical intern, Sarah, consistently leaves her shift early, often leaving patient charts incomplete. You’ve frequently found yourself staying late to finish Sarah’s documentation, which is adding to your already considerable workload.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Approach Sarah to discuss the problem, ask if she's facing any issues that are preventing her from completing her tasks.
C) Tell the other interns not to assist in completing Sarah's tasks to teach her a lesson.
A) Delegate some of Sarah's unfinished tasks to another intern without discussing it with Sarah.
E) Report the issue to your consultant.
D) Insist that Sarah arranges a meeting with the ward's senior doctor and head nurse to discuss her inability to complete tasks.

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You’re the on-call medical intern in a busy ER. With the sudden influx of patients, you delegate an IV line placement to a nurse. The nurse refuses to place the line on a patient who has Hepatitis C.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Threaten the nurse with a report to the supervisor if she refuses to place the IV line.
E) Ask the nurse about her specific concerns and discuss potential solutions to increase her comfort level.
B) Explain to the nurse the professional duty to provide care to all patients.
C) Place the IV line yourself.
A) Assign another nurse to place the IV line, but avoid telling them about the patient’s Hepatitis C status to prevent fear.

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The oncology nurse asks you to discuss the next steps with Tom, a patient who was recently diagnosed with a terminal cancer. You were away for a medical conference for the last week and are not aware of Tom’s prognosis or treatment history. All your seniors are currently in a critical patient review and you are the only doctor available on the ward.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Request the oncology nurse to summarise Tom's case history before meeting him.
D) Ask the oncology nurse if she can postpone the meeting until your seniors are free as they are more acquainted with Tom's case.
A) Agree to converse with Tom, after reading his medical notes thoroughly.
C) Join the conversation with Tom but refrain from answering any medical queries.
E) Enter the meeting with Tom and catch up on the case as the nurse converses with him.

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You are interested in cardiology and have been asked to ‘scrub in’ and assist with a coronary angioplasty. The cardiologist is willing to spend longer with you in the cath lab provided that you consent the patient. You have not obtained consent for a surgical procedure before, but understand about some possible complications.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Ask the medical registrar to consent the patient.
D) Refuse to consent the patient.
C) Admit to the patient that you are unfamiliar with consenting for the procedure but that he can ask the cardiologist later on if he has questions that you cannot answer.
A) Attempt to consent the patient, and refer any specific questions to the anaesthetist who will conduct a preoperative assessment later on.
B) Ask the cardiologist to run through the procedure with you before consenting the patient.

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You are asked to speak to a new patient who is a heavy drinker and has been admitted following an episode of severe alcohol withdrawal. He insists he is fine and wants to leave the hospital, despite showing symptoms of delirium tremens.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Explore his reasons for wanting to self-discharge.
C) Call his family members to influence his decision.
A) Explain the severity of his condition, the dangers of discharge, and emphasize the risk of serious complications if he were to self-discharge.
D) Discuss with the nursing staff if there's any approach that might be causing his restlessness.
E) Avoid engaging with the patient as he is likely under the influence and may not be cooperative.

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You are attending to a teenager in the A&E who has been admitted with signs of suspected alcohol poisoning. The physical examination shows signs of acute intoxication, and you also note that the teenager’s parents appear to be distressed and emotional. You are now considering what to document in your medical notes.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Write a brief summary of your clinical assessment.
D) Complete your notes later after attending to other patients, to keep the clinic moving.
A) Complete your notes after they have been confirmed by a senior doctor.
C) Conduct a detailed physical examination and objective clinical assessment of the teenager.
E) Document your opinion of the parents’ emotional state, based on their appearance.

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While you are working in the Emergency Department (ED), you are inserting a chest tube in a patient with a suspected pneumothorax. Just as you are about to secure the tube, your emergency pager goes off for a potential cardiac arrest in the next bay.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Respond to your pager after securing the chest tube, cleaning the work area, ensuring the patient is stable and handing over to the nursing staff.
D) Stop your current procedure immediately and attend the cardiac arrest.
E) Try to get the attention of the ED Charge Nurse so that she can respond to your pager.
A) Ignore the pager as they will call again if it is important.
C) Secure the chest tube and ensure it is functioning correctly before responding to the emergency pager.

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You are a psychiatry junior doctor in a busy outpatient clinic. You have a flight to catch for an important conference the same evening. There are still two patients left to be seen. One patient has a history of long-standing, well-controlled bipolar disorder, and the other patient, who is always accompanied by their family, often raises complex social issues that require time to address.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Explain to the patients and their families that you are running short on time today, and assure them that someone will be available to address any remaining questions at their next appointment.
C) Conduct a quick assessment of each patient, without engaging in any detailed conversations.
A) Request the clinic nurse to ask the families to leave so you can finish your consultations quickly.
E) Spend as much time as needed with the patients, addressing all their questions and concerns, even if it means missing your flight.
B) Inform the clinic nurse that the patients will need to be rescheduled to the next available appointment date and leave for your flight.

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While working the night shift in the Intensive Care Unit, you notice Bob, one of the nursing assistants, speaking in a harsh manner to a patient with severe Alzheimer’s disease. This patient can often be challenging due to his cognitive impairment and behavioural issues.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Report the situation directly to hospital administration.
A) Don't act on the situation as the patient's cognitive impairment might make him unaware of the treatment.
B) Discuss with other staff if they've noticed Bob's inappropriate behavior.
D) Speak to Bob directly about his behavior.
E) Report the behavior to a senior nurse on shift.

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A patient who was admitted for heart failure is unhappy with the lack of communication and attention from the medical team over the past few days. She is considering filing a formal complaint and discusses this with you.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Give her the contact information for the Patient Advice and Liaison Service (PALS) to explore their options.
B) Explain to the patient that due to understaffing issues, the level of attention might be lower than usual, and a complaint could potentially instigate improvements.
A) Advise the patient that filing a formal complaint might not bring about the desired changes.
E) Engage her in a conversation to understand the events that have led to her dissatisfaction.
D) Inform your senior that the patient is contemplating a complaint.

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You’re a junior doctor in an Oncology department. A young woman newly diagnosed with cervical cancer confides in you that she doesn’t want her traditional family to know about her diagnosis, fearing their reactions and possible ostracism.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Inform the nursing staff that her family is not aware of her diagnosis and to be cautious about disclosing information.
B) Inform her that her family is likely to discover her condition eventually, so it would be better if she informs them.
E) Treat her with the same protocols and privacy measures as any other patient in your care.
A) Assure her that you will not include her diagnosis on patient lists visible to non-medical staff.
D) Promise her that you will not mention cervical cancer in her medical records.

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You are an intern working in the orthopedic department. Your consultant requests you to consent a patient whom you have just examined in the emergency department for a possible femoral head replacement due to an acute hip fracture. Your consultant needs to attend to another emergency case and cannot consent the patient himself.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Attempt to take the consent as best as you can.
D) Request an orthopedics SPR who has performed the operation in the past to take the consent.
C) Request the consultant to get in touch with a senior colleague who is off-duty.
A) Contact the medical consultant on call.
E) Ask the consultant to consent the patient as soon as he is done with the current emergency case.

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You are about to conduct a bedside teaching session with a patient who has advanced liver cirrhosis. The patient, with distinct clinical signs, has given his consent to aid the teaching session for your medical students. However, as you and your students approach his room, you notice that the patient looks visibly distressed and upset.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Educate the students outside the room that emotional distress is common in patients with a terminal illness.
A) Continue with the planned session hoping that it could distract him from his current emotional state.
E) Approach the patient first to discuss his feelings and see if there's anything you could do to assist him.
B) Decide not to enter the room, presuming he may no longer agree to be a part of the teaching session given his state of distress.
D) Inquire with the patient if he still feels comfortable assisting in the teaching session with the medical students.

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Linda has recently been diagnosed with rheumatoid arthritis. During her outpatient clinic visit, she asks her rheumatologist to explain what this means, and the rheumatologist says that you, as a resident, will talk to her later about the condition.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Inform Linda that "rheumatoid arthritis" essentially means that the joints are inflamed due to the body attacking itself.
D) Ask Linda what she understands so far and what she wants to know.
B) Advise Linda that there are some excellent resources online and she should research more about the condition once she is home.
E) Hand Linda a patient information brochure provided by the clinic.
A) Tell Linda that "rheumatoid arthritis is an autoimmune condition in which the body's immune system mistakenly attacks the joints."

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Dr. Smith, the senior consultant, has asked you to arrange a lumbar puncture procedure for a patient with a suspected neurological condition. However, when booking the procedure, you only find the option for ‘CT-guided lumbar puncture.’ He instructs you to book this and later inform the department to amend the request. You have reservations about this strategy due to prior experiences with incorrect procedures being carried out.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Express your reservations and recount previous incidents where such strategy has led to errors.
E) Contact the procedure department first, then book the 'CT-guided lumbar puncture.'
A) Submit a clinical incident report concerning Dr. Smith's apparent readiness to compromise patient safety.
B) Request Dr. Smith to arrange the procedure under his name.
C) Book a CT-guided lumbar puncture procedure and then call the department to amend your request.

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Your head nurse is about to administer a complex set of medications to a critical patient. She has a reputation for being a bit harsh and earlier she asked you to keep quiet while she is preparing the medications. Although you have been somewhat distracted, you believe you saw her preparing an excessive dose of one drug, but you are not entirely sure.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Cross-check the patient's medication chart yourself.
B) Keep silent as you were not completely attentive.
E) Ask an indirect question such as: "What would be the effects if a high dose of this drug was given?"
C) Immediately point out your concern to the head nurse.
D) Ask a random question to lighten the atmosphere before discussing the possibility of an overdose.

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You are a GP Trainee and your clinical supervisor has agreed to complete an evaluation for your rotations but hasn’t done so yet. The deadline for submitting all evaluations is fast approaching.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Inform your Local Scheme Director about the difficulty you're experiencing in getting evaluations.
E) Ask for your supervisor's login details to fill in the evaluation form yourself.
C) Remind your supervisor about the approaching deadline.
D) Inform the National GP Training Director that you are having trouble getting evaluations done.
B) Approach a different supervisor to complete an evaluation.

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You have just concluded an emergency case presentation for Mrs. Davis, a 68-year-old woman with severe chest pain, to Dr. Bennett, the on-call cardiology consultant. The next morning, Dr. Silva, the new on-call cardiology consultant, reviews your case presentation and proposes an entirely different treatment plan, without additional information or examining the patient. You are uncomfortable with Dr. Silva’s suggestions.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Request clarification from Dr. Silva regarding who is ultimately in charge of the case.
A) Request the registrar to review Mrs. Davis for a 'third opinion'.
B) Politely refuse to implement Dr. Silva's treatment plan until she examines Mrs. Davis.
C) Proceed with Dr. Silva's treatment plan.
D) Discuss the discrepancies between Dr. Bennett's and Dr. Silva's proposed treatment plans.

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Rachel, a 75-year-old lady with a history of moderate dementia, has been in the hospital for a few weeks following a hip fracture. With the help of the physiotherapy team, she has recovered her mobility to her usual baseline. Her family, however, express several concerns to you that they feel need to be addressed before Rachel is discharged.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Support Rachel's niece, who feels that Rachel needs help managing her apartment.
D) Address her daughter's worries about potential financial exploitation by a supposed friend, using appropriate assessment tools.
E) Consider her brother's worries that her memory loss is deteriorating and that she needs additional medical care.
A) Arrange residential care home as requested by her sister.
C) Discuss the family's concerns with Rachel, and seek her point of view first.

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You have planned a bedside teaching session for a group of five medical students with a patient on your ward suffering from rheumatoid arthritis. When you arrive, you find her extremely upset due to a flare-up of her condition and an ongoing argument with her insurance provider. You had previously agreed to spend an hour with the patient and students, and you don’t have any other patient available for the teaching session.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Emphasize that emotional stress is a typical part of chronic illnesses, and continue with the bedside teaching as planned.
D) Use the situation as a teaching moment in communication skills by discussing her insurance troubles.
C) Start the teaching, but agree to stop if her distress continues.
A) Switch to teaching the students medical theory in a lecture room instead
E) Disregard the problem and focus your teaching strictly on the examination of the patient's rheumatologic signs.

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You are an intern working in a cardiovascular ward, and during the morning round, you notice a patient looking quite anxious. The attending cardiologist notes that understanding the cause of this anxiety is crucial before discussing any potential treatment options. You ponder how you might proceed to address this.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Schedule a 20-minute dedicated conversation with the patient to talk about any worries or concerns.
D) Reach out to the family members to try to gain insight into the patient's worries.
E) Leave it up to the patient to discuss their concerns voluntarily, without any prompting.
C. Ask the ward clerk to talk to the patient and try to identify any issues.
A) Request the nurse assigned to the patient today to find out what's bothering the patient.

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You are an intern in a geriatric ward. Robert is a patient with early-stage Alzheimer’s who is refusing to take his prescribed medications, despite your recommendations and his son’s pleas. His son tells you about a previous prolonged discussion between other doctors and his father, which resulted in Robert eventually being “overridden,” and asks you to avoid similar delays and start the medication right away.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Proceed with the treatment despite Robert's objections.
B) Avoid making a decision and seek the advice of a senior colleague.
A) Ask the son to assist in your assessment of Robert's capacity.
E) Review the medical records to determine whether Robert lacks the capacity to make this decision.
C) Evaluate Robert's capacity to refuse this treatment.

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You are seeing Olivia, a 35-year-old woman. She mentions to you about her friend who was recently diagnosed with diabetes. This news has alarmed her, and Olivia is concerned about her own risk of developing diabetes. She read some articles online and now wants a complete panel of blood tests.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Prescribe medication for anxiety.
D) Order a complete panel of blood tests.
C) Conduct a thorough health history and physical examination.
A) Explain the drawbacks and invasiveness of unnecessary blood tests.
B) Explain that her absolute risk of developing diabetes is low.

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You are currently doing rounds on the geriatric ward with your SHO. Both of you have numerous tasks that need to be completed by the end of the shift. Your SHO asks you to postpone referring Mr. Smith, a patient suffering from severe shortness of breath, to the respiratory team until the next day, due to the high likelihood of needing to perform a bronchoscopy, which will lead to additional tasks that are time-consuming. You are concerned as Mr. Smith appears to be in increasing discomfort.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Assign the task of referring the patient to a nurse, even though you are aware that 'doctor-to-doctor' referrals are generally expected.
B) Finish the list of tasks assigned by your SHO before referring the patient to the respiratory team later in the day.
C) Follow your colleague’s instructions and make the referral to the respiratory team the following day.
D) Report to your consultant that the SHO is neglecting Mr. Smith.
E) Discuss the importance of timely management of severe respiratory symptoms with your SHO and propose a rearrangement of tasks.

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You are an intern in your first month working on the gastroenterology ward. You have grown increasingly concerned about your registrar’s abilities. You have noticed her incorrectly interpreting fundamental clinical signs. Once, you attempted to express your concerns to the consultant, but he dismissed them, emphasizing the registrar’s expertise in endoscopic procedures.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Share your concerns with another intern.
D) Discuss the matter with your Educational Supervisor.
E) Ask the registrar if she would be open to receiving some additional teaching from you after hours.
A) Report the issue to the Clinical Director.
B) Reiterate your concerns to your consultant, emphasizing the registrar’s overall performance.

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You are reviewing patients in the Accident and Emergency Department (A&E). A former classmate from medical school approaches you and informs you that his mother is one of the patients waiting to be reviewed. He asks you to see his mother first.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Reject your classmate's request immediately.
B) Determine if there is a specific reason why he wants you to see his mother immediately.
E) Review your classmate's mother last, as a form of reprisal for his inappropriate request.
D) Report your medical classmate to his training coordinator.
A) Consult with the registrar to see if they have a preference for which patient you should see next, and if not, begin with your classmate's mother.

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Emma is a 30-year-old patient with Multiple Sclerosis. Upon checking her medication chart, you notice several missed doses of medication. When you inquire with the nurse who’s been overseeing Emma since her admission, she says that the patient has been declining to take her medication. However, Emma has always been cooperative with you and denies ever being given the medication by the nurse.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Report the nurse to the Nursing and Midwifery Council.
B) File a clinical incident report for the failure to adequately encourage Emma to take her medication.
A) Convert all of Emma's medication to intravenous forms.
C) Inform the Incharge Nurse that Emma hasn't been receiving her medications and request for further investigation.
E) Suggest to the nurse that she spends time with Emma and motivates her to take her medication.

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You are a new physician in an outpatient clinic. During a routine check-up, Mark, a 42-year-old commercial airline pilot, reveals to you that he has recently been experiencing occasional blackouts. Although he promises to avoid flying until the issue is resolved, you overhear him telling his wife on the phone that he doesn’t want to jeopardize his job and plans to continue his regular flying duties.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Ask Mark to sign a written agreement not to fly until the blackout issue is resolved.
B) Inform the Aviation Medical Examiner (AME) about Mark's condition.
D) Inform Mark's primary care provider about the situation.
E) Accept that you are not responsible for the patient's actions once you have appropriately instructed him.
C) Seek assurance from Mark's wife that he will not fly.

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You are working as senior house officer in a cancer hospital. A 45-year-old father of three, Mr. Jackson, notices you as you pass by his room. He looks worried and calls you in. He has recently had a biopsy for a suspicious lung mass and asks, “What if it turns out to be lung cancer?”

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Validate his concern, saying, "I understand you are worried about the possibility of having lung cancer."
B) Comfort him with words that everything will turn out to be okay.
D) Request Mr. Jackson to hold his queries and direct them to your senior doctor.
A) Remain silent and look away, attempting to indicate the severity of his situation without words.
C) Reassure Mr. Jackson that the medical team will do everything in their capacity to treat his condition.

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You walk into the hospital room to find an intern physician conducting a physical examination on a female patient with the door wide open. The patient does not seem to express any discomfort.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Close the door quietly.
D) Ask the patient for her preference and leave the door open if she is comfortable with it.
E) Explain the importance of patient privacy to the intern afterward, if there seems to be a misunderstanding.
C) Publicly tell the intern that he should learn to respect privacy.
A) Continue with your work as there doesn't seem to be an issue and you shouldn't interfere.

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During your daily rounds on the oncology ward, your registrar informs a patient that he will need a ‘Whipple procedure’, which would involve removal of part of his pancreas and other organs. The patient signs a consent form, but from his expressions, it seems he still has some queries but doesn’t voice them.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Demand that the registrar stay back to answer the patient's queries.
E) Continue with the rounds but stay behind to draw a diagram of the Whipple procedure for the patient.
A) Inform the patient that the registrar will return later to address his concerns.
B) Move ahead with the rounds but plan to revisit the patient later to answer any queries.
C) Assure the patient that you will return after the rounds to answer any further questions he may have.

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Mrs. Martinez, an elderly patient with advanced Alzheimer’s disease, has been admitted for recurrent urinary tract infections. During her admission, you come across an indefinite DNAR (Do Not Attempt Resuscitation) order that has been in place since her previous admission. Upon speaking to Mrs. Martinez’s daughter, who is her primary caregiver, it appears that she is unaware of the existence of this order.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Apologize for the lack of communication from Mrs. Martinez's previous doctors.
B) Inform your senior about the situation immediately.
A) Invalidate the DNAR order.
E) Avoid informing Mrs. Martinez's daughter about the DNAR order for the time being, and opt to discuss it later with her privately.
D) Explain the reasoning behind the DNAR order, given Mrs. Martinez's condition.

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You are making rounds on a busy hospital floor when you notice an elderly patient struggling to reach the call button on the bedside table.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Tell the patient that he needs to be more cautious about placing the bottle within his reach.
D) Go to the patient, take the bottle and hand it over to him without any discussion.
B) Approach the patient and ask if he needs help with his water bottle.
C) Report the situation to the nurse assigned to that patient.
A) Yell from your place to the patient, guiding him how to properly hold the bottle.

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During your shift at a psychiatric hospital, you’re asked to prescribe a safety helmet for a particular patient. The helmet is designed to prevent self-harm through head banging. You agree to prescribe it only under certain conditions.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) The patient lacks capacity to understand his own actions.
C) The patient lacks capacity and has a history of self-harm through head banging.
A) The patient exhibits periodic outbursts of anger.
D) The patient lacks capacity, has harmed himself before by head banging, and all other preventive strategies have failed.
E) The patient lacks capacity and has a history of self-harm through head banging. However, the patient's family strongly opposes the use of a safety helmet.

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A patient admitted to your ward with a highly contagious gastrointestinal virus has been asked to remain in his room as much as possible and adhere to strict hygiene practices. He also has been informed that public health authorities must be notified about his condition. However, he refuses to allow his health information to be shared and frequently leaves his room without practicing recommended hygiene measures.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Despite the patient's objections, submit his details to the public health authorities.
E) Assure the patient that his information won't be shared externally, but insist that his primary healthcare provider must be notified.
B) Try to understand why the patient is not following the recommended protocols.
D) Explain to the patient that his disease is highly contagious and could easily infect others in the hospital.
A) Discharge the patient from the hospital without further treatment, as his behavior could put others at risk.

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Maria is an elderly woman with severe Parkinson’s disease who often wanders around the care home during the night. Her mobility is unpredictable, and she can become agitated and combative when caregivers try to guide her back to her room.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Request that a dedicated caregiver be assigned to monitor her one-to-one during night hours.
B) Suggest engaging activities, such as puzzles or gentle exercise, to divert her attention.
A) Discuss with Maria, as much as she can understand, that it's not safe for her to wander around unattended.
E) Prescribe medication to be given when Maria becomes particularly agitated and poses risk to herself or others.
C) Prescribe 'as needed' (PRN) medication for agitation.

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You are caring for George, an 83-year-old patient in a nursing home who has moderate dementia. During your rounds, he shares with you that he dislikes having the nursing staff bathe him each evening. He tells you that at home, his caregiver used to be present while he bathed, stepping in only if he needed assistance. This process was slower but he preferred it that way.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Tell George that you have no authority to change how the nursing home operates.
A) Inform George that he could resume his preferred routine once he gets back home.
D) Assure George that he can bathe himself each evening if he wants, with supervision if needed.
C) Explain to George that it may not be feasible as the nursing staff are often busiest in the evenings.
E) Relay George's request to the Charge Nurse and suggest that it be mentioned during the nursing handover.

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A patient informs you that they suspect their nurse has been accessing their medical records without permission.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Ask the nurse to provide an explanation and disclose any unauthorized access to the patient's medical records.
D) Request the patient to gather any evidence or specific incidents of unauthorized access before escalating the situation.
B) Verify the patient's claim by reviewing access logs and confirming any unauthorized activity before taking further action.
C) Report the incident to the hospital's privacy officer or designated authority responsible for handling privacy breaches.
E) Inform your supervisor or department head about the patient's concerns and seek.

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You are on a surgical ward and notice a nurse administering medication to a patient, but you suspect she may have accidentally given the wrong dose.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Confront the nurse directly and question her about the possibility of administering the wrong dose.
B) Observe the situation closely and double-check the medication order to confirm if there was an error.
A) Immediately intervene and stop the nurse from administering any further medication.
D) Report the incident to the charge nurse or nurse manager responsible for the ward.
C) Discuss your concerns with another nurse or senior colleague to get a second opinion.

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You are a junior doctor in the obstetrics and gynecology department. As all the interns are changing jobs, the ward clerk asks you to complete a discharge summary for a patient who was discharged last week after a complicated delivery, including arrangements for follow-up.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Attempt to complete the discharge summary and try to find the consultant or registrar on duty to discuss and confirm the follow-up arrangements.
D) Write a letter to the previous intern in the obstetrics department and ask them to complete the discharge summary for their patient.
A) Refuse and ask the ward clerk to find the doctor who was looking after the patient.
E) Complete the discharge summary to the best of your ability and arrange a routine follow-up appointment in the obstetrics clinic in six weeks.
B) Ask the new SHO in the obstetrics department to try to complete it.

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During a ward round, you notice that one of your senior colleagues is consistently speaking to patients in a condescending and disrespectful manner. A patient approaches you and expresses their discomfort with the way the senior colleague communicates. They do not wish to file a formal complaint, but they suggest that you take action regarding the colleague’s behavior.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Raise the concern privately with your senior colleague.
E) Explain that the senior colleague may have had a bad day and that patients should understand the challenges doctors face.
D) Establish specific instances and details of the colleague's disrespectful behavior.
C) Apologize to the patient and assure them that you will address the issue with the senior colleague.
B) Inform the hospital's patient advice and liaison service (PALS).

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You are working with a registrar who unintentionally prescribes a medication that the patient is allergic to, but you catch the error before it is administered. The registrar expresses relief and acknowledges that both the patient and themselves had a fortunate escape.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Inform the hospital's patient safety officer about the incident.
C) Discuss the incident with the registrar privately and provide guidance on double-checking prescriptions.
A) Apologize to the patient for the error and assure them that necessary measures will be taken to prevent a recurrence.
D) Document the incident in the patient's medical records.
E) Conduct a root cause analysis to identify the underlying factors contributing to the prescribing error.

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You have recently joined a surgical team as a NCHD(Non-Consultant Hospital Doctor). During the surgical rounds, you have noticed that some team members frequently make inappropriate jokes and derogatory comments about patients based on their ethnicity or other personal attributes. These comments create a disrespectful and unprofessional environment.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) File a formal complaint with the hospital's HR department.
B) Arrange a meeting with the entire surgical team to discuss the importance of maintaining a respectful and inclusive environment.
C) Speak privately with the team members involved and express your concerns about their inappropriate comments.
D) Report the behavior to your immediate supervisor or department head.
A) Ignore the comments and focus solely on your own work.

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You are junior doctor working in a busy emergency department. One of your colleagues, Sarah, has been displaying signs of increasing stress and fatigue. She has been making more errors in patient management and appears overwhelmed. You are concerned about her well-being and the potential impact on patient care.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Approach Sarah privately and express your concern for her well-being.
E) Discuss the situation with a senior colleague or supervisor for guidance.
D) Offer assistance to Sarah in managing her workload or seeking support.
C) Document any incidents or errors related to Sarah's performance.
A) Ignore the situation and hope that it resolves on its own.

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You are conducting a routine check on the patients’ vital signs and notice that one of the patients who requires oxygen therapy is not receiving it, even though it was prescribed by the doctor.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Immediately provide the patient with the prescribed oxygen therapy.
C) Double-check the patient's medical records and prescription to ensure the correct oxygen therapy is prescribed.
B) Inform the nurse in charge about the situation and the missed treatment.
E) Monitor the patient closely for any signs of distress and wait to see if the nurse eventually administers the oxygen.
D) Confront the nurse responsible for the patient and insist on administering the oxygen therapy right away.

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George is an elderly gentleman who suffers from COPD and is under your care in the respiratory ward. He is on continuous oxygen therapy and needs assistance to move around due to breathlessness. It takes considerable effort to get him to the toilet, which often turns out to be unneeded as he does not always feel like going afterward.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Ask George for his views and whether he is bothered by the numerous trips to the toilet.
D) Explain the problem to George and then propose using a urinary catheter once he consents.
E) Tell George that he needs a urinary catheter and then place it carefully.
B) Suggest alternatives such as a bedside commode or a urinal bottle.
C) Consult with the pulmonology team to see if there are any additional interventions that can be done to manage George's breathlessness.

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You’re the on-call doctor overnight in the hospital and you receive a call from the nurse on the geriatric ward. She insists that you immediately come to review an elderly patient, Mrs. Smith, because she believes the patient is not receiving adequate pain control. You’re currently attending to a critical patient in the ICU and there are still multiple tasks to be completed. The nurse says she will call your consultant if you don’t come immediately, even though you’ve already assessed Mrs. Smith’s pain as well controlled during your last round.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Tell the nurse to call your consultant as you are currently tied up in the ICU.
C) Leave the critical patient in the ICU and immediately attend to Mrs. Smith as per the nurse's request.
B) Assure the nurse that you have evaluated Mrs. Smith's pain and found it well-controlled, but promise to discuss it with your consultant during morning handover.
D) Promise the nurse that you will re-evaluate Mrs. Smith's pain management as soon as you are done with your immediate duties in the ICU.
E) Tell the nurse that you will hand this over to the morning team.

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You are a senior house officer working in a busy hospital ward. One of your colleagues, Mark, frequently neglects his ward duties to spend more time in the operating theater. Except for the morning rounds, you haven’t seen Mark on the ward for at least five weeks. The registrar seems to be okay with this arrangement as long as the tasks are completed, and you don’t have a particular interest in theater.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Suggest that SHO's should be prohibited from assisting in the operating theater.
A) Do nothing as you enjoy the ward and Mark clearly wants to be in the operating theater.
B) Speak to Mark and insist that he spends more time on the ward.
E) Talk to Mark and suggest dividing theater and ward time more evenly.
C) Go to the operating theater and leave any ward tasks until after hours when both you and Mark can attend to them.

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You are GP Trainee working in a busy hospital. Your consultant frequently requests that you perform tasks that are beyond your level of experience and competence. This puts you in a difficult position as you want to provide the best care for your patients while also respecting your limitations.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Speak privately with your consultant and express your concerns about being assigned tasks beyond your level of experience.
E) Continue to accept and perform the tasks assigned by your consultant, even if you feel uncomfortable or unprepared.
D) Discuss the situation with the hospital's medical education department or your educational supervisor.
C) Document your concerns and incidents where you feel your competence has been compromised.
B) Seek guidance from more experienced colleagues or senior doctors on how to handle the situation.

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You work in a busy hospital where the electronic health record (EHR) system frequently malfunctions, causing delays and errors in patient care. The system crashes at least once a week, leading to frustration among healthcare professionals and potential harm to patients.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

B) Document specific instances of patient care delays and errors caused by the EHR system malfunctions and report them to your Clinical Supervisor.
E) Ignore the EHR system issues and continue working with the flawed system to avoid causing disruptions in patient care.
A) Bring up the issue with the hospital's IT department and request immediate resolution of the EHR system problems.
C) Engage with colleagues and organize a meeting to discuss the impact of EHR system issues on patient care and workflow.
D) Seek guidance from a more experienced healthcare professional on alternative approaches to ensure patient safety during EHR system failures.

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You notice a conversation between two of your medical trainees, Sarah and Lisa. Sarah recounts a recent incident where she self-prescribed medication to help manage her chronic condition after losing her regular prescription. She appears to be unaware that this is an issue and hasn’t indicated that she plans to tell anyone about this.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Ignore the issue as it appears Sarah was trying to manage her health responsibly and didn’t intend any harm.
B) Schedule a meeting with Sarah’s training program director to discuss what you heard.
E) Ask Lisa for more details about the incident.
A) Inform Sarah that you will be reporting her to the Irish Medical Council.
C) Talk to Sarah about what you heard, and whether she understands the regulations related to self-prescribing.

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During a busy clinic session, you notice your registrar with an acute headache. She informs a nurse that she forgot her migraine medication at home. She then receives a dose of sumatriptan from the clinic’s drug cabinet.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Report the registrar for taking clinic medication.
C) Write a prescription for the sumatriptan for your colleague.
B) Suggest that she goes to the Emergency Department to get a proper prescription for the migraine medication.
E) Do nothing.
D) Express your concern to the nurse who gave her the medication.

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You are a junior doctor working in a busy hospital. During your shift, you notice a colleague mishandling medications and administering the wrong dosage to a patient. The patient is at risk of harm if the mistake is not corrected.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Report the incident to the hospital's patient safety officer.
D) Discuss the situation with your senior doctor or consultant.
A) Immediately intervene and correct the medication error.
E) Ignore the mistake and hope that it is not discovered.
B) Inform the nurse in charge about the medication error.

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You realize that a fellow doctor is having difficulty interpreting ECGs, despite being well into her training program.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) Suggest your colleague to seek assistance from a senior cardiologist.
D) Call the registrar urgently to share your worries about her.
B) Overlook the issue unless a serious misinterpretation happens.
E) Send an email to her Training Director informing about the situation.
A) Offer to tutor your colleague on ECG interpretation and recommend relevant educational resources.

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You are assisting a senior cardiologist during a cardiac catheterizations procedure. You have seen many catheterization during your training, and you are certain that the cardiologist has inadvertently entered the left subclavian artery instead of the right. The cardiologist denies this, and when you ask him to confirm the entry point, he seems uncertain.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Excuse yourself from the procedure room and contact the head of the department, asking him to come to the operating room.
D) Insist that the cardiologist stops as you are confident a mistake has been made.
C) Wait until the procedure is completed before discussing the issue with the head of the department.
A) Accept that the cardiologist is much more experienced and likely correct.
B) Ask the anesthesiologist to become involved.

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Peter is a geriatric patient on the cardiac ward who is currently attending bi-weekly physical therapy sessions. After evaluating him, you believe he may benefit from more frequent sessions.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Stick with the physical therapist's current treatment plan.
C) Involve Peter and his family in a meeting with the interdisciplinary team to voice their concerns.
D) Discuss your thoughts with other members of the interdisciplinary team before the weekly meeting.
B) Ask the physical therapist whether they think Peter could benefit from more frequent sessions.
E) Tell the physical therapist that they should increase the frequency of Peter's sessions.

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You are at a busy pediatric clinic and the lead nurse alerts you that a 5-year-old child in one of the examination rooms appears to be having a seizure. You are the most experienced doctor present, but also in the room are a final year medical student, an intern and a porter.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Wait for instructions from the nurse.
A) Instruct the medical student to time the seizure.
C) Instruct the porter to bring the emergency seizure medication.
B) Encourage the intern to lead the seizure management to develop his clinical skills.
D) Ask the intern to bring the emergency seizure medication, while you assess the child.

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You are the on-call doctor overnight in the hospital. A nursing assistant pages you for the fifth time in two hours to ask you about minor issues that could have been handled by the regular staff during daytime hours or issues that are not immediately critical.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Explain to the nursing assistant the importance of distinguishing between urgent and non-urgent issues, considering the limited number of on-call doctors.
B) Accept the page and add the task to your list, regardless of its urgency.
A) Visit the ward and request the charge nurse to triage all further pages from the nursing assistant.
E) Tell the nursing assistant to stop paging you for non-critical issues.
C) Listen to the page, gather necessary information, and then determine the priority of the task.

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You are a junior doctor in a busy general surgery ward. Your fellow junior doctor, a friend from medical school, has recently taken up a new hobby and leaves work 30 minutes early each day to attend their practice sessions. As a result, you find yourself staying late often to complete pending tasks. You understand the importance of work-life balance, but you’re also starting to feel overwhelmed by the additional workload.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Discuss your concerns directly with your friend and fellow junior doctor.
D) Inform your friend that you'll bring up the issue with your consultant unless they adjust their schedule.
C) Schedule a meeting with your supervising consultant to discuss the situation.
B) Ask your friend to arrive to work 30 minutes earlier to make up for their early departure.
E) Verify whether the practice sessions are temporary or a long-term commitment.

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You are managing a patient who you suspect may have a deep vein thrombosis (DVT). Your consultant has asked you to arrange a Doppler ultrasound to confirm this. However, the radiographer has twice denied your request, first for insufficient clinical detail, and then due to lack of convincing laboratory results. Your consultant insists that the scan needs to be completed today.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

D) Discuss the situation with your consultant.
E) Explain to the radiographer that your consultant has evaluated the patient and if they are unwilling to do the same, they should accept the scan request.
C) Bring the patient's medical records and speak to the radiographer in person.
A) Decide not to order the Doppler ultrasound scan.
B) Seek another radiographer's opinion.

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You are working an evening shift in the emergency department and you have accumulated a substantial list of tasks to accomplish. This includes six ECGs, an urgent lumbar puncture which was due two hours ago, two IV insertions, and three admissions to coordinate. You ponder over how you will get everything done.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Contact the on-call nurse to request assistance while you head to the urgent lumbar puncture.
D) Join your peers in the break room to strategize your tasks and ask for help if needed.
B) Request the help of another junior doctor.
C) Delegate your list of tasks to the ward nurse and ask him to call you if there are any issues.
A) Prioritize the urgent lumbar puncture that was supposed to be done two hours ago and then order the other tasks by urgency.

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You notice that Mark, a recently hired Physician Assistant, has ordered an unnecessary blood transfusion for a patient. Mark is adamant that the transfusion is necessary, even after you express your concerns. He cites his “years of experience” in justifying his decision.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Explain your reasoning as to why you believe the transfusion is not necessary.
B) Affirm your disagreement and halt the transfusion order as you bear the ultimate responsibility for patient care.
C) Agree to the transfusion but plan to discuss with the patient's GP to cease such orders in the future.
E) Consent to the transfusion but don't sign off on the order.
D) Notify Mark that you'll consult with a superior colleague about the matter, and in the meantime, the transfusion should not proceed.

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You are nearing the end of your GP rotation in Paeds. The position was more demanding than you had anticipated, and you found the initial induction process to be lacking. Now, you’re thinking about ways to assist the person who will take your place.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Take time off your upcoming rotation to guide your successor during their initial week.
C) Inform your Clinical Supervisor about your thoughts on the induction during your end of rotation review.
B) Let the clinical management team handle the induction process.
A) Leave your personal email address for your successor to reach you if they need help.
D) Prepare a guide with useful advice and pointers for your successor.

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You are an SHO on a geriatric ward, and you’ve been tasked with determining the preferences of Mr. Clarkson, a patient recovering from a severe knee injury, regarding his ongoing care and potential transfer to a rehabilitation facility. Mr. Clarkson has a hearing impairment and communicates through sign language, which you are not familiar with. You also have a series of urgent tasks to complete before an impending consultant ward round.

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

D. Contact Mr. Clarkson’s family to understand his usual preferences and wishes.
A. Attempt to communicate with Mr. Clarkson using written notes before addressing other tasks.
C. Decide on Mr. Clarkson's behalf to transfer him to a rehabilitation facility, considering his physical condition.
E. Request the assistance of a hospital staff member who is proficient in sign language to communicate with Mr. Clarkson.
B. Wait for Mr. Clarkson's relative who knows sign language to visit later in the day to facilitate communication.

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You are an SHO working in a geriatric unit. After finishing your rounds, you realize that your bag containing patient charts is missing from the staff lounge. These charts contain sensitive information about your patients’ health status.

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

A. Wait to see if the bag turns up before taking any action.
C. Report the incident to the Garda to start an official investigation.
B. Immediately inform your supervisor about the missing bag and its contents.
E. Notify hospital security to check for any unusual activity and assist in locating the bag.
D. Ask your colleagues if they noticed anyone suspicious or unfamiliar around the staff lounge.

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You are a junior doctor and have noticed that your registrar often arrives late to the morning handovers. The consultant, who usually arrives after the registrar, is not aware of this. The constant tardiness is affecting the smooth transition of care and you’ve observed other staff members’ growing frustration.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

E) Ask the registrar if there are any issues causing their repeated lateness.
B) Speak to the registrar privately to express your concerns about their lateness.
D) Propose a "timekeeping agreement" that everyone on the team should adhere to.
A) Inform the consultant about the registrar's late arrivals.
C) Start the handover without the registrar when they are late.

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Your colleague, a junior doctor, is often seen leaving the hospital with boxes of unused gloves and masks. You’re aware that he uses them to practice his clinical skills at home.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

A) Inform his Clinical Supervisor via email about your observations.
C) Overlook the act considering your colleague's intent is to enhance his clinical skills.
E) Request your colleague to return the hospital supplies immediately.
D) Notify the hospital inventory manager about the missing supplies.
B) Confront your colleague, stating that if the action continues, you'll have to report him.

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You are examining a nine-month-old infant in the emergency department who has been brought in by their parents after an episode of severe vomiting. On examination, you find that the child has multiple piercings on their ears. The parents say that the piercings were performed by a professional piercer in accordance with their cultural beliefs.

Rank the following actions in order of appropriateness (1 = Most appropriate; 5 = Least appropriate).

C) The examination finding constitutes evidence of child abuse, and Child Protection Services should be informed immediately.
A) The piercings do not require treatment on this admission, as they have nothing to do with the presenting complaint.
D) Refer the patient to a pediatric surgeon for further assessment.
E) Refer the parents to parenting classes for failing to act in accordance with their child's best interests.
B) Document the findings and discuss the management options with your consultant.

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SJT-Ranking Questions

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