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    S4 Sample3

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    S4 Sample3

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    Sample

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    S4-Sample3

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    9 views4 pages

    S4 Sample3

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    of 4

    INFORMATION FOR THE CANDIDATE

    Scenario No: Sample 2

    PACES Station 4: COMMUNICATION SKILLS &


    ETHICS
    Your role: You are the doctor on the acute medicine unit
    Problem: Administration of an antibiotic treatment to the wrong patient
    Patient: Mrs Anne Smith, a 55-year-old woman

    Please read the scenario printed below. When the bell sounds, enter the room. You have 14
    minutes for your consultation with the patient/relative, 1 minute to collect your thoughts and 5
    minutes for discussion. You may make notes if you wish.

    Where relevant, assume you have the patient’s consent to discuss their condition with the
    relative/surrogate.

    Scenario:
    Towards the end of a long and busy shift, you were asked by a nurse to administer the first dose of
    an antibiotic to a patient, for management of pneumonia.

    Following administration of the drug, you realised that you had made an error in identification of
    the patient and administered the treatment to a patient with a similar name. This patient, who has
    chronic obstructive pulmonary disease, has been clinically assessed and observed and has come to
    no harm.

    Your have reported the error to a senior member of the medical team seeking advice on what to do
    and have agreed to speak to the patient to discuss the situation.

    Your task is to explain the error to the patient.

    DO NOT EXAMINE THE PATIENT

    DO NOT TAKE A HISTORY

    Any notes you make must be handed to the examiners at the end of the station.

    ©2015 The Royal Colleges of Physicians of the United Kingdom


    NOT TO BE SEEN BY CANDIDATES
    INFORMATION FOR THE SURROGATE
    Scenario No: Sample 2

    PACES Station 4: COMMUNICATION SKILLS &


    ETHICS
    Your role: You are the patient, Mrs Anne Smith, a 55-year-old woman
    Problem: Administration of an antibiotic treatment to the wrong patient

    Scenario:
    You were admitted overnight with a worsening of your symptoms of wheeze and breathlessness.
    You have a past history of chronic obstructive pulmonary disease and have smoked approximately
    20 cigarettes per day all your adult life. Your recently completed a 1-week course of antibiotics with
    a reduction in your sputum production. The sputum is no longer green.

    On admission to hospital, the doctor in the emergency department indicated that there were no
    signs of infection on examination and that blood testing and chest X-ray were normal. You have
    been admitted for treatment with nebulisers, steroids and for further investigation. You were told
    that you would not need a course of antibiotics and were surprised when the doctor arrived earlier
    to give you intravenous antibiotic treatment.

    The doctor has called to explain that there has been a medication error and you have been given a
    course of antibiotic inadvertently.

    Attitude and emotional responses


    You are upset and angry that you have received a treatment that was not needed.
    You are worried that this might cause harm as you are aware that too many antibiotics can cause
    resistance to treatment and bowel infections.
    You understand that the ward is very busy and that the medical staff are under pressure while
    looking after a large number of patients.

    Make sure you ask the following question:


     How could this problem have occurred and who is responsible?
     Will I come to any harm?

    Other questions you might like to ask include:


     How can this problem be prevented in the future?

    ©2015 The Royal Colleges of Physicians of the United Kingdom


    NOT TO BE SEEN BY CANDIDATES
    INFORMATION FOR EXAMINERS
    Scenario No: Sample 2

    PACES Station 4: COMMUNICATION SKILLS &


    ETHICS
    DATE CYCLE

    Examiners should advise candidates when there are 2 minutes remaining (i.e. after 12 minutes). If
    the candidate appears to have finished early remind them how long is left at the station and
    enquire if there is anything else they would like to ask, or whether they have finished. If they have
    finished, please remain silent and allow the candidate that time for reflection. The surrogate should
    remain until the end of the 14-minute period.

    A good candidate would be expected to have agreed a summary plan of action with the subject
    before closure. Nonetheless, in discussion, the examiners will usually ask the candidate (after one
    minute’s reflection) to summarise the problems raised in the foregoing exchange.

    The candidate should be asked to identify the ethical and/or legal issues raised in this case and how
    they would address them. The framework for discussion should include consideration of these four
    underlying principles:
    – Respect for the patient’s autonomy
    – Duty to do good
    – Duty to do no harm
    – Legal aspects (a detailed knowledge of medical law is not required)

    Candidates are not expected to have a detailed knowledge of medical jurisprudence. For overseas
    candidates in the UK, detailed knowledge of UK law is not required, although candidates should be
    aware of general legal and ethical principles that may affect the case in question.

    The candidate should recognise his/her limit in dealing with a problem and know when, and from
    where, to seek further advice and support.

    Examiners should refer to the marking guidelines in the four skill domains on the marksheet.

    Examiners are reminded that, during the calibration process, the surrogate should be rehearsed
    and specific aspects of the scenario that require clarification or emphasis should be discussed. The
    boxes on the next page indicate areas of potential interest in this case which both examiners should
    consider, along with any other areas they feel appropriate. Examiners must agree the issues that a
    candidate should address to achieve a Satisfactory award for each skill and record these on the
    calibration sheet provided. Examiners should also agree the criteria for an Unsatisfactory award at
    each skill.
    NOT TO BE SEEN BY CANDIDATES
    INFORMATION FOR EXAMINERS
    Scenario No: Sample 2

    Problem: Administration of an antibiotic treatment to the wrong patient


    Candidate’s role: The doctor on the acute medicine unit
    Surrogate’s role: The patient, Mrs Anne Smith, a 55-year-old woman

    Examiners are reminded the areas below indicate areas of potential interest, but are not intended
    as absolute determiners of Satisfactory performance. It is for the examiners to agree and record the
    specific criteria they will assess the candidate on during the calibration process.

    During the interview please use the following question to explore aspects of
    communication and ethical interest:

     What are the key ethical issues arising from this case?

    Clinical Communication Skills (Clinical Skill C)


     Provides a clear explanation of the medical error
     Openness, honesty and transparency
     Listens to the patient and shows empathy

    Managing Patients’ Concerns (Clinical Skill F)


     Acknowledges the patient’s concerns and explains management plan
     Recognises ethical and legal considerations around the case
     Understands how the problem has occurred and how it can be avoided in future

    Clinical Judgement (Clinical Skill E) (also points of ethical interest)


     Is aware that a clinical incident has occurred and needs to be reported (Examiner to explore
    details)
     Seeks senior help and takes clear documentary record of events and discussion with patient
     Engagement with senior team and clinical supervisor
     Risk management strategies to prevent future errors

    Maintaining Patient Welfare (Clinical Skill G)


    See marksheet

    ©2015 The Royal Colleges of Physicians of the United Kingdom

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