Domain 1 - Professional, Ethical and Legal Practice
Domain 1 tests whether you can practise safely inside the legal and ethical frame that surrounds every clinical decision: consent, confidentiality, competence boundaries, documentation and reporting duties. Items usually present a short scenario containing a conflict - a relative demanding information, a patient refusing care, a colleague working outside their competence - and ask for the first or most appropriate action.
Consent is a process, not a signature
- Valid consent requires three elements: voluntariness, capacity and sufficient information (nature, purpose, material risks, alternatives, and the consequences of refusal).
- Capacity is decision-specific and time-specific. A patient may lack capacity for a complex discharge plan yet retain it to agree to a dressing change.
- Adults are presumed capacitous. Assess capacity; never infer its absence from a diagnosis of dementia, learning disability or mental illness.
- Where capacity is absent, act in the person's best interests, choose the least restrictive option, and involve family as informants rather than decision-makers unless they hold legal authority in your jurisdiction.
Confidentiality and information sharing
- Share the minimum necessary information on a need-to-know basis.
- Disclose without consent only where law requires it, or where a serious risk to the patient or public outweighs the duty of confidence. Escalate through the proper channel rather than deciding alone.
Scope of practice and accountability
You remain accountable for tasks you delegate. Delegate only when the task is within the delegate's competence and you can supervise. Recognise the limits of your own competence and escalate early.
Documentation
Records must be contemporaneous, factual, signed and dated: what you observed, what you did, what you advised, and the response. Correct errors with a single line through, initialled and dated - never obliterate or rewrite.
Worked example
A 78-year-old with moderate dementia, admitted after a fall, pulls away and says "no" when you attempt to stand him. His daughter says, "Just make him do it, he's always like this."
Reasoning: the question is not "does he have dementia?" but "does he have capacity for this decision, now?" Use short sentences, ensure hearing aids and glasses are in place, explain why standing matters and what happens if he does not. If he understands, retains, weighs and communicates a refusal, the refusal stands - even if his daughter disagrees. If capacity is genuinely absent, decide in his best interests with the team, use the least restrictive approach (analgesia before transfer, two-person assistance, timing), and document the assessment and rationale. Tell the daughter what you can share without breaching his confidentiality.
Traps that cost marks
- Treating capacity as global, or assuming a diagnosis removes it.
- Accepting a relative's consent for a capacitous adult.
- Recording labels ("uncooperative", "difficult") instead of observable behaviour.
- Answering "ask the doctor" when the correct action is to escalate and document your own concern.