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Iraqi Board General Surgery study materials
Iraqi Board General Surgery study resources

Iraqi Board General Surgery: Professionalism, Ethics, Patient Safety, Research and Evidence-Based Surgery

Iraqi Board General Surgery · Work through your exam, one topic at a time.

All guide sections

Professionalism, Ethics, Patient Safety, Research and Evidence-Based Surgery

This domain is the one candidates most often under-prepare. Questions reward knowing the legal and ethical framework and being able to read a study result.

Consent and capacity

  • Valid consent requires capacity, adequate information and voluntariness. Assess capacity with four abilities: understand, retain, weigh and communicate a decision.
  • The Montgomery standard replaced Bolam for consent: disclose the risks a reasonable person in the patient's position would want to know, plus any specific concern the patient has raised.
  • Adults with capacity may refuse any treatment, including life-saving surgery. In an unconscious patient with no proxy, treat in their best interests under the doctrine of necessity.

Patient safety

  • The WHO surgical safety checklist (sign in, time out, sign out) reduces mortality and complications.
  • Never events such as wrong-site surgery, retained swabs and wrong implants trigger root cause analysis, not individual blame.
  • Human factors: SBAR handover, graded assertiveness and speaking up across hierarchy.

Research and evidence

  • Evidence hierarchy: systematic review or meta-analysis, then randomised trial, cohort, case-control, case series, expert opinion.
  • Sensitivity = true positives / all with disease; specificity = true negatives / all without disease. Positive predictive value depends on prevalence.
  • Absolute risk reduction = control event rate minus treatment event rate; number needed to treat = 1/ARR.
  • Audit compares practice with an existing standard using PDSA cycles; research generates new knowledge and needs ethics approval and consent.

Worked example

A trial reports mortality of 10% with standard care and 5% with a new drug. ARR = 5% (0.05), so NNT = 1/0.05 = 20 - twenty patients treated to save one life. Quoting the absolute figures and NNT is clearer to a patient than a 50% relative risk reduction.

Traps

Quoting relative rather than absolute risk reduction; assuming a highly sensitive test confirms disease when prevalence is low; consenting without disclosing a material risk; calling a complication a never event without systematic review.