Practice-Based/Professionalism
Core concepts
This domain tests judgment, ethics, and systems-based practice. Know informed consent: capacity, disclosure of risks/benefits/alternatives, and the emergency exception. Understand medical error disclosure and the duty to be honest with patients. Review professionalism: boundaries, conflicts of interest, and appropriate relationships with industry. Know the principles of quality improvement and patient safety (root cause analysis, checklists, and the Swiss cheese model). Understand documentation and billing compliance, and the role of peer review. Also cover end-of-life communication, shared decision-making, and cultural competence. Recognize the importance of reporting impaired colleagues and the limits of confidentiality.
Traps
Examiners test the difference between capacity and competence (capacity is a clinical determination; competence is legal). Another trap is the desire to hide a complication; disclosure is expected. Do not forget that informed consent is a process, not a signature.
Rule of thumb
When in doubt, disclose: honesty about errors and transparency with patients is both ethical and expected.
Worked example
A resident notices a wrong-site surgery about to happen: stop the line, speak up, and follow the universal protocol; patient safety overrides hierarchy.