This page contains practice interview questions and a brief explanation of points to cover for each question. It is not intended to accurately reflect Interview scenarios or questions for GPVTS, but is provided here as a useful revision tool and to help extend your knowledge where little other information is freely available.
Often the best way to practice is to work with a partner or learning group. These questions might form the basis of such a group and you can use them to test each other.
What Do You Know About The Hospital At Night Project?
What Do You Understand by Patient's Confidentiality?
Tell Me About The European Working Time Directive (EWTD)
What Is Modernising Medical Careers (MMC)?
How Might You Go About Breaking Bad News?
What Is Gillick Competence? What Are The Fraser Guidelines?
Talk About The Expanding Role Of Allied Health Professionals
What Is Involved In Obtaining Informed Consent?
What Does NICE Stand For? What Do They Do?
What Is Evidence Based Medicine? What Are The Different Levels Of Evidence?
What Attracts You To General Practice?
What Qualities Do You Consider Important To Make A Good GP?
Should We Accept Gifts From Patients?
What Are The Duties of A Doctor?
What Should You Do If Your Consultant Comes Into Clinic Drunk?
The hospital at night project (HAN) is a new model developed to achieve more effective clinical care at night than previous traditional models of night - working. The project set about to define areas for improvement to the hospital working environment at night and to make recommendations for change. The evidence gathered supports better care delivered through the presence of one or more multidisciplinary teams who between them have the full range of skills and competencies to meet patient's needs between them at night time. In 2002 the JCC (Joint consultants committee) identified that competency based multi-disciplinary teams at night would help hospitals move towards European working time directive compliance. The project advocates the following recommendations :
For non-medical staff to take on a proportion of the work done by doctors at night.
To move a significant proportion of the work to the extended day.
To reduce duplication of work, e.g. through reduction in multiple clerking.
Supervised mulit-disciplinary handover
Confidentiality is central to trust between doctors and patients and in order for the best possible patient care in vulnerable situations. Seeking patient's consent to 'disclosure' when deemed important is part of good communication and medical practice. There are several important areas of disclosure to be borne in mind where the patient has the option to refuse:-
Implied consent in the sharing of information within the healthcare team is understood by most patients, but they have the right to object
You must be satisifed that you have obtained informed consent for clinical audit and respected their right to object to the disclosure.
Express consent must be made for research purposes and where doctors have contractual obligations to third parties
There are, however, disclosure's required by law:-
Suspected or confirmed communicable disease, the patient must be informed, but consent is NOT required.
You are required to disclose information if ordered by a court judge, but should object if you believe personal information is irrelevant.
The most difficult area are disclosures 'in the public interest'. You must take measures to evaluate your actions before proceeding, namely:
The benefits to society must outweight the patient's interest/damage to the doctor-patient trust relationship
You have taken measures to ensure that it is not practical to anonymize the data
If practical you should try to seek patient's consent (The GMC may equire you to justify your actions if a complaint is made about the disclosure of identifiable information without a patient's consent)
This directive was enacted in UK law in 1998 and lays down the minimum safety and health requirements for the organisation of working time and applies to periods of rest, daily, weekly and annual leave, certain aspects of night work, shift work and patterns of work. It applies to all sectors of activity, not just hospitals! Doctors in training may voluntarily opt-out of the provisions of the Directive by signing a waiver stating that they choose to work in excess of the average weekly hours. Some, BUT NOT ALL, of the requirements are:-
No more than 48hrs per. week
11 hours continuous rest in a 24hr period.
120 minute break after 6hr work
The Jaeger ruling states that compensatory rest must be taken immediately after the period of work that generated it.
There is a 'phasing in' period which aims to get maximum hours requirements down to 48 per. week in 2009. Interestingly, the SiMAP ruling at the European court on behalf of a group of Spanish doctors deemed all work 'on-call' whether present at the hospital or not to be regarded as "working time" in its entirity. Currently GPs do not fall within the remit of the EWTD as they are self employed.
In formulating your argument you may wish to consider:
Arguments for
Greatly improved work/life balance
Increased efficiency within the NHS
Potentially less monotonous work and more focussed training for doctors
Scope for training of more doctors and medical staff
Arguments against
Shorter hours means less training
Increased work load of consultants and registrars who 'have done their time'
Feared increase in duration of training post to compensate for reduced hours
Expensive to instigate
Reduced pay due to compliant banding
Ways to implement EWTD
Extension of nursing roles (including minor surgery, admission and discharge of patients, ordering investigations and prescribing)
NHS funding is set to increase by 7.4% in England and Wales over the next 5 years
Effective Bleep Policies for reduced staff under increased work load
More effective use of consultants (obviously controversial)
This is an initiative to develop a better method of training for tomorrows doctors. It is founded on demonstrable competence. As part of this the MMC has formed two foundation years that require doctors to demonstrate their abilities against set competencies and standards.
Subsequent entry into specialist training will be focused and 'streamlined'. Progression into specialist training is also intended to be 'seamless' with specialism choice made during a broader exposure in the foundation programme. Specialist training is also intended to become competency based rather than 'time' based.
Much of the drive for this has come from the European Working Time Directive (EWTD) and success of the Hospital At Night project (HAN). There is also focus within the MMC on properly taught trainers.
More can be found on the MMC Website
The Foundation Programmes are part of the new Modernising Medical Careers (MMC) initiative to introduce competency based training for junior doctors. It replaces the old PRHO/SHO system and comprises two years of ongoing development post qualification. It therefore encompasses general training which forms the bridge between medical school and specialist training. National implementation of the programme began in August 2005.
One of the goals of the Foundation Programme training is to provide better understanding of both primary and secondary care. From August 2007, there will be opportunities for 80% of trainees to undertake a placement in general practice.
More can be found on the MMC Website
Various UK guidelines exist for how to go about breaking bad news and you should adopt your own, a possible format is as follows:
Setting up
Find a quiet private area
Ensure you have adequate time for the interview
Avoid interruptions, block phone calls
Gain support from a nurse or colleague for the interview
Ask if the patient would like someone present
Ensure there are no language barriers, ie.interpreter if required
Clarify names and relationships of relatives/staff and give good introductions
Determine The facts (what is known, what is percieved, what is expected)
How much do they know? How much do you know? What are the options? What do they expect?
Re-iterate the facts of the case and events to date.
Give results at the patient's pace
Do you want to discuss the results?
Prepare the patient e.g. I'm afraid the news is not good - The results are not normal - We have found some abnormal cells.
Don't avoid talking about cancer!
Give the patient time to come to terms with the news
Don't be uncomfortable with silences
If suitable : how are you feeling? What worries you most?
Follow up and where to go from here
Give realistic advice about treatment and future options
Organise follow up and time to ask questions
Offer to speak with a relative
The case of Gillick formed the principle that a young person under the age of 18 years is allowed to give consent for treatment, without parental consent if there is full understanding to enable him or her to understand what is involved. (Gillick v. West Norfolk and Wisbech Area Health Authority [1985]).
The Fraser Guidelines are sometimes also referred to as 'Gillick' Competencies, and sets out to help a professional determine if a child is capable of understanding fully the implications of a treatment and to make a choice about the use of treatment e.g. contraceptive.
For example, a health professional may provide contraception, including abortion, to a young person without parental consent provided that:
The young person has full understanding and capacity to make a decision as above
The doctor is unable to persuade the young person to inform their parents or guardian.
Continuation of intercourse wihout contraception/protection is likely
It is in the best interest of the young person
Doctors and other health professionals have a duty of care regardless of patient's age (GMC 2004)
This is part of the Government's Strategy for Change and Agenda in modernising the NHS. Encouraged by the hope of reducing waiting lists and meeting the demands of an overstretched NHS, in part as a result of the new European Working Time Directive
Consider
Impact on patients
Impact on other health professionals
Impact on health services delivery
Patient-led NHS
From spring 2006, qualified Extended Formulary nurse prescribers and pharmacist independent prescribers will be able to prescribe any licensed medicine for any medical condition - with the exception of controlled drugs.
The Nurse Prescribers' Extended Formulary (NPEF) was introduced in April 2002, originally for four therapeutic areas: minor injuries, minor ailments, health promotion and palliative care. It was expanded in 2003 and again in May 2005, to cover an extended range of medicines and conditions outside the original therapeutic areas, mainly for emergency care and first contact care. The NPEF now contains around 240 Prescription Only Medicines (POMs) - including some controlled drugs and over 6,100 Extended Formulary. Nurse Prescribers can diagnose, prescribe for and manage 110 medical conditions.
Over 450 pharmacists and over 5,700 nurses have qualified to become "Supplementary Prescribers". Prescribing is defined as a voluntary partnership between the independent prescriber (a doctor or dentist) and a supplementary prescriber to implement an agreed patient-specific Clinical Management Plan, with the patient's agreement. Such a partnership can be particularly helpful for patients with a long-term condition such as asthma or diabetes. A nurse or pharmacist may be well placed to prescribe for the patient's continuing care.
Refer to GMC - Informed Consent!
You must be satisfied that a patient has given informed consent before you undertake any examination or screening, provide treatment, or involve them in teaching or research
Before seeking consent you must give patients information, in a way they can understand, so that they can make an informed decision. You must encourage and support patients to use their expertise to be involved in decisions about their care, and you should try, wherever possible, to reach agreement
Where a patient lacks capacity to give consent you must act in the patient's best interests and in accordance with the relevant law
In an emergency, where consent cannot be obtained, you may provide treatment which is immediately necessary, respecting a patient's advance wishes, if known or drawn to your attention
"A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish."
G Scally and L J Donaldson, 'Clinical governance and the drive for quality improvement in the new NHS in England' BMJ (4 July 1998): 61-65. Click Here To View This Article
The values behind clinical governance are often given as Acountability, Transparency and Openess
It encompasses the following:
The installation of clinical governance teams to assure the quality of care provided
Reflective Practice, which includes Audit and Evidence Based Best Medical Practice
Multidisciplinary Team Working
Incident reporting and Risk Management
Appraisal for Doctors
Efficient Use of Resources
Patient Satisfaction
N.I.C.E = The National Institute for health and Clinical Excellence, It is an independent organisation.
NICE produces guidance in three areas of health:
Public Health
Guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
Health Technologies
Guidance on the use of new and existing medicines, treatments and procedures within the NHS
Clinical Practice
Guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
They also provide support and tools to implement their guidelines within organisations, such as costing templates and audit advice.
"Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." (Centre for Evidence Based Medicine)
Levels of evidence refers to a system of grading for the validity of evidence about prevention, diagnosis, prognosis, therapy, and harm. They are often quoted as levels 1 - 5 with subdivisions within each level. This is the system used by Bandolier and is given as:
Strong evidence from at least one published systematic review of multiple well-designed randomised controlled trials.
Strong evidence from at least one published properly designed randomised controlled trial of appropriate size and in an appropriate clinical setting.
Evidence from published well-designed trials without randomisation, single group pre-post, cohort, time series or matched case-controlled studies.
Evidence from well-designed non-experimental studies from more than one centre or research group.
Opinions of respected authorities, based on clinical evidence, descriptive studies or reports of expert consensus committees.
Obviously a personal question, some points to bear in mind:
Continuity of care.
As a G.P. you are often the only 'consistent' interface with the health care profession. You will often follow patients through initial presentation and diagnosis and in the subsequent course of their illness. You may get to know not just your patients but their families as well.
Being your own boss.
General Practice involves many aspects of management, financial and resource, personal, staffing and of course medical. You have more flexibility and control over your practice than is often the case in a hospital setting.
It is General.
General Practice involves a wide range of disciplines and indeed a multi-disciplinary approach to patient management. You are required to be well-versed and up to date in all areas of modern medicine and not just focused in one small area.
Opportunity for G.P. with specialist interest.
In answering this question you should refer to the National Person Specification, namely :
Empathy and Sensitivity
Capacity and motivation to take in patient/colleague perspective
Treats patient(s) with sensitivity and personal understanding
Empathetic and checks patient needs are satisfied
Generates safe/ understanding atmosphere
Communication Skills
Engages patients/colleagues in equal/open dialogue. Clarity in both verbal & written communication
Uses different questioning styles and probes for information to lead to root cause
Capacity to adjust behaviour/language (written/spoken) as appropriate to needs of differing situations
Clinical Knowledge and Expertise
Capacity to apply sound clinical knowledge and awareness to full investigation of problems
Makes clear, sound and proactive decisions, reflecting good clinical judgment
Conceptual Thinking and Problem-solving
Thinks beyond the obvious to get to root cause
Use of lateral thinking and insight
Is open to new ways of thinking
Can judge what is important from a mass of information
Professional Integrity
Capacity and motivation to take responsibility for one's actions
Admits when mistakes are made
Respects / defends contribution and needs of all
Coping with Pressure
Recognises own limitations and 'shares the load with others'
Calm under pressure and able to 'switch-off' outside work
Able to develop appropriate coping mechanisms and is prepared to ask for help
Personal Organisation Administration Skills
Able to organise a mass of information in a structured and planned manner
Can prioritise conflicting demands and delegates when necessary
Effective time management and use of IT systems
Managing Others and Team Involvement
Demonstrates a collaborative style
A skilled negotiator, able to motivate others
A team player who contributes to and facilitates decision-making and develops trust
Views self as part of larger organization
Uses resources efficiently
According to the standard General Medical Services Contract (GMS regulations;2004;Gifts) all doctors are obliged to keep a register of gifts to the value of £100 or more and to disclose the register to the Primary Care Trust on request.
Key points
Is it ethical to accept the gift?
The GMC advises that doctors must not encourage patients to give, lend or bequeth money or gifts which will directly or indirectly benefit you, you must be open and honest in all dealings (GMC Good Medical Practice, 2005).
Gifts can provoke complaints from other family members
It must be explicitly stated to the patient that acceptance of such a gift would not influence the patient's care
Patient's sometimes later change their minds
The General Medical Council (GMC) sets out a series of 'duties of a doctor' as guidance to all doctors in registration. It contains a list of fourteen key areas to which all practitioners should follow. They are:
Make the care of your patient your first concern
Treat every patient politely and considerately
Respect patients' dignity and privacy
Listen to patients and respect their views
give patients information in a way they can understand
Respect the rights of patients to be fully involved in decisions about their care
Keep your professional knowledge and skills up to date
Recognise the limits of your professional competence
Be honest and trustworthy
Respect and protect confidential information
Make sure that your personal beliefs do not prejudice your patients' care
Act quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be fit to practise
Avoid abusing your position as a doctor; and
Work with colleagues in the ways that best serve patients' interests.
This refers to our ethical duty as set out by the GMC
"Protect patients from risk of harm posed by another doctor's or healthcare professional's conduct, performance or health, including problems arising from substance misuse. The safety of patients must come first at all times"
Whilst the format for dealing with such a situation is always personal, a possible structured approach is set out below to help you. You can contact your defence union or the General Medical Council for assistance and further guidance.
Step 1
Aproach your consultant. Be supportive. State your concerns and confirm whether or not you are correct. You may wish to engage other colleagues, such as the ward sister, before approaching your consultant. But you must make patient safety your priority.
Step 2
Persuade your consultant to go home for the day. If there is difficulty in discussion between yourselves then, again, you should engage help from your registrar or other ward staff.
Step 3
Inform your consultant that if you felt there was a risk to patient care then the GMC would expect you to give an honest explanation to an appropriate person from the employing authority.
Indeed, if you do not act on your concerns you could be called upon to justify your actions to the GMC at a later date
Step 4
Make sure that effective cover is in place for absence of duty.
Step 5
Inform a senior, as per your local trust guidelines, such as the clinical director. Or refer to the GMC.
Step 6
Follow up to ensure that the situation has been sufficiently adressed.
Blink
Del.icio.us
Digg
Furl
Google
Simpy
Spurl
Y! MyWeb