Ethics, Professionalism, and Patient Safety
What OMRSE tests
Ethics, Professionalism, and Patient Safety tests consent, capacity, confidentiality, truth telling, error disclosure, and resource allocation. The best answer respects autonomy while documenting a safe, transparent process.
Core rules
- Informed consent requires capacity, adequate information, voluntariness, and the patient's decision; a signature alone is not consent.
- Capacity is decision-specific: understanding, appreciation, reasoning, and expressing a choice. A competent adult may refuse life-saving treatment.
- Confidentiality can be broken only with consent, legal requirement, or serious public-health risk; share the minimum necessary.
- Disclose harmful errors promptly, apologize, explain what happened, and describe prevention; do not blame systems or hide facts.
Worked example
A 70-year-old with a gangrenous foot refuses amputation. He is alert, understands the risk of death, explains that he values comfort over survival, and gives a consistent choice. Assess capacity formally; treat pain, delirium, or depression if present. If he remains capacitated, respect the refusal, document the discussion, and offer palliative care. Family agreement is not required, although family meetings can clarify values. Do not proceed because the team believes surgery is in his best interests.
Traps that cost marks
- Equating old age or a psychiatric diagnosis with incapacity.
- Asking the family to consent for a competent adult.
- Breaching confidentiality in a corridor conversation.
- Hiding a medication error to avoid blame.