Ethics, Professionalism and Patient Safety
What candidates must know
Ethics and professionalism underpin safe practice. Understand the four principles (autonomy, beneficence, non-maleficence, justice), informed consent (capacity, voluntariness, information), confidentiality and its limits, and the duty of candour after harm. Know how to assess capacity (understand, retain, weigh, communicate), how to act in the patient's best interests when capacity is absent, and the management of conflicts of interest. Patient safety concepts include human factors, the Swiss-cheese model of error, incident reporting, and the importance of a blame-free reporting culture. Understand professional boundaries, consent in minors, and the recognition of impaired colleagues.
Traps in questions
- Capacity is decision-specific and time-specific - a patient may lack capacity for one decision but not another.
- Consent is a process, not a signature; the patient must be informed of material risks.
- Confidentiality can be breached only where there is a legal or ethical duty (risk of serious harm, statutory reporting).
- Duty of candour: disclose harm openly and apologise - an apology is not an admission of liability.
- Reporting errors is a professional duty; questions test the reporting, not the concealment.
Rule of thumb
Respect autonomy unless capacity is absent or harm is imminent. The correct answer usually protects the patient's right to decide while ensuring they are informed and safe.
Worked example
A competent adult refuses a life-saving transfusion on religious grounds. After confirming capacity and informed refusal, the ethical response is to respect the decision and document it - not to override it, provided capacity is intact and no dependent third party is at risk.
Evidence-Based Practice
What candidates must know
Evidence-based practice (EBP) integrates best evidence, clinical expertise and patient values. Understand the hierarchy of evidence (systematic reviews and RCTs above cohort and case-control studies, above expert opinion), the PICO framework for formulating a question, and the critical appraisal of study validity, results and applicability. Know the meaning of confidence intervals, p-values, number needed to treat (NNT), absolute versus relative risk, and the difference between statistical and clinical significance. Understand bias types (selection, measurement, publication), confounding, and the principles of guideline appraisal (AGREE) and GRADE certainty.
Traps in questions
- Relative vs absolute risk: a 50% relative reduction sounds large but may be trivial in absolute terms - always ask for baseline risk.
- NNT = 1/ARR; a low NNT means more effective.
- p-values indicate statistical significance, not effect size or clinical importance.
- A wide confidence interval crossing the null means the result is inconclusive, not negative.
- Guidelines can conflict; appraise the evidence base rather than following the label.
Rule of thumb
Convert to absolute terms. Whenever a trial reports a relative risk reduction, calculate the absolute risk reduction and NNT to judge whether the effect matters for your patient.
Worked example
A trial reports a drug reduces events from 2% to 1% (RRR 50%). The absolute risk reduction is 1%, NNT = 100 - clinically modest. The correct interpretation weighs this against cost and harms rather than celebrating the 50%.
Research and Quality Improvement
What candidates must know
Research and quality improvement (QI) are distinct but complementary. Understand study designs (RCT, cohort, case-control, cross-sectional, qualitative), sampling and randomisation, and the principles of measurement validity and reliability. Know the PDSA cycle (Plan-Do-Study-Act) as the engine of QI, and the Model for Improvement (aim, measures, changes). Understand the difference between research (generates generalisable knowledge, needs ethics approval) and QI (improves local practice, often exempt but still ethically governed). Know basic descriptive and inferential statistics, the interpretation of audit against standards, and how to close the loop with re-audit. Familiarity with informed consent, data protection and research ethics is expected.
Traps in questions
- Audit vs research: audit measures practice against a standard; research tests a hypothesis and generates new knowledge.
- PDSA is iterative and small-scale - not a single large project.
- Correlation is not causation; confounding must be considered in observational designs.
- QI does not require the same ethics approval as research, but ethical safeguards still apply.
- Closing the loop: re-audit after implementing change is essential.
Rule of thumb
Ask what the project is for. If it compares current practice to a known standard, it is audit; if it tests whether an intervention works, it is research; if it tests small changes to improve a process, it is QI.
Worked example
A clinic finds only 60% of diabetic patients have annual foot checks. The QI approach is a PDSA cycle: plan a reminder system, test it on a small sample, study the results, then act and re-audit - not a one-off lecture to staff.
Clinical Procedures and Practical Skills
What candidates must know
Procedural competence combines indication, consent, asepsis, technique and aftercare. Understand the principles of safe practice: correct patient identification, informed consent, hand hygiene, sterile field, and sharps safety. Know the technique and complications of common procedures - venepuncture, cannulation, IM/subcutaneous injection, urinary catheterisation, wound suturing, abscess incision and drainage, and ECG recording. Understand local anaesthetic use (maximum safe doses, avoiding adrenaline in digits with caution), and the recognition and management of needlestick injury (wash, report, risk assessment, PEP). Know how to document a procedure and give aftercare advice.
Traps in questions
- Consent and asepsis come before technique - questions test the sequence.
- Needlestick injury: immediately wash with soap and water, report, and assess for HIV/HBV/HCV PEP - do not squeeze or suck the wound.
- Local anaesthetic toxicity: know maximum doses and avoid intravascular injection.
- Catheterisation: aseptic technique and documented indication; remove as soon as possible to prevent CAUTI.
- Documentation of consent, procedure and aftercare is part of the skill.
Rule of thumb
Prepare before you puncture. For any procedure, the correct first step is confirm identity, obtain consent, and establish asepsis - technique follows preparation.
Worked example
A clinician sustains a needlestick from a known hepatitis-B-positive patient. The correct immediate action is to wash the wound with soap and water, report the incident, and assess for post-exposure prophylaxis (HBV vaccine/immunoglobulin, HIV PEP as indicated) - not to ignore it or to squeeze the site.