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    (Original post by Helenia)
    "competent according to the Fraser guidelines" might play it even safer!
    Awesome thank you
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    (Original post by purple and gold)
    has anybody got any difficult questions for me??
    What do you know about the audit process?
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    hey guys would you recommend any interview prep courses ?? or any books (other than isc 2nd edition) ??
    Thanks
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    (Original post by FlavaFavourFruit)
    What do you know about the audit process?
    okay, well its a process in order to ensure that the quality of healthcare provided by a practise is of a high standard.
    Essentially it is preformed as an "audit cycle" whereby its carried out and then is carried out again at a later period of time.
    So generally, A topic for investigation is chosen, then a standard is defined, all relevant data is collected in a surgery, recommendations are made on how the surgery can measure up to a standard, time is given for implications to be made and then is re-audited in order to ensure than the changes are functional.

    Any more questions?
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    (Original post by purple and gold)
    okay, well its a process in order to ensure that the quality of healthcare provided by a practise is of a high standard.
    Essentially it is preformed as an "audit cycle" whereby its carried out and then is carried out again at a later period of time.
    So generally, A topic for investigation is chosen, then a standard is defined, all relevant data is collected in a surgery, recommendations are made on how the surgery can measure up to a standard, time is given for implications to be made and then is re-audited in order to ensure than the changes are functional.

    Any more questions?
    Competition is tough this year good response!
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    No one answered my question
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    What should you (as a GP) do if a patient refuses to receive information? (also if anyone has time, see my question on the previous page )
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    I have a 'Gillick Competence' thought for the day for you all: this was a real case experienced by one of my fellow med students back in our 4th year (More than 20 years ago but just as relevant today as then…)

    A 15 year old was referred to O+G requesting TOP (termination of pregnancy). She was only 8 or 9 weeks pregnant so it seemed like a 'reasonable' request with the only complication being that she insisted that her parents not be told anything about it. The Gynae team caring for her agreed that she was 'Gillick' competent and that she understood the risks of the procedure (medical TOP didn't exist back then so it was a surgical TOP with risks of ensuing infection, haemorrhage and infertility that were the issue) so she was scheduled for an ultrasound scan to confirm gestation, an appointment with a counsellor (to ensure that she was psychologically in a good place to make such a mammoth decision) and a social work team member (to ensure that she wasn't being sexually abused/pressured).

    What are your thoughts so far?

    Don't read the next bit, just imagine whether you might feel comfortable with the thought that this 15 year old is dealing with this on her own...

    OK, if you've committed your thoughts on the lat bit then read on...

    The social workers were happy; no concerns.

    The counsellor agreed that she was a sensible young thing without signs of any mental illness impairing her judgement they had no concerns about the assessment regarding her being Gillick competent to make the decision for a TOP.

    The US scan showed her to have a molar pregnancy.

    Molar pregancy is effectively a cancer generated from a failed pregnancy. It grows in the same way a tumour grows and requires (at the very least) a thorough surgical evacuation of uterus with lots of cautious follow-up but (at worst) can need drastic surgery and can cause death in just the same way that any other cancer can.

    She's 15

    Is she still Gillick competent or do you insist on phoning her mum?
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    (Original post by SiMan)
    A question, seems quite straightforward but just want to see other people's responses.

    A student visits his local GP, telling her that he suffers from high amounts of stress at times and it really affects his daily activities. He also suffers from hypertension which he believes may be linked to his stress issues. He later reveals he is a medical student and that it is getting in the way of his learning and ability to make rational decisions at times. However he tells her about how he loves medicine and really wants to become a doctor one day. How should the doctor respond to his situation.

    ***This question is made up and may/may not be accurate to any medical symptoms or diagnosis, if you just understand the point I'm making about how should the GP consider his health and his future occupation***
    What do you think are the issues in this question?
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    (Original post by Dr Gin)
    I have a 'Gillick Competence' thought for the day for you all: this was a real case experienced by one of my fellow med students back in our 4th year (More than 20 years ago but just as relevant today as then…)

    A 15 year old was referred to O+G requesting TOP (termination of pregnancy). She was only 8 or 9 weeks pregnant so it seemed like a 'reasonable' request with the only complication being that she insisted that her parents not be told anything about it. The Gynae team caring for her agreed that she was 'Gillick' competent and that she understood the risks of the procedure (medical TOP didn't exist back then so it was a surgical TOP with risks of ensuing infection, haemorrhage and infertility that were the issue) so she was scheduled for an ultrasound scan to confirm gestation, an appointment with a counsellor (to ensure that she was psychologically in a good place to make such a mammoth decision) and a social work team member (to ensure that she wasn't being sexually abused/pressured).

    What are your thoughts so far?

    Don't read the next bit, just imagine whether you might feel comfortable with the thought that this 15 year old is dealing with this on her own...

    OK, if you've committed your thoughts on the lat bit then read on...

    The social workers were happy; no concerns.

    The counsellor agreed that she was a sensible young thing without signs of any mental illness impairing her judgement they had no concerns about the assessment regarding her being Gillick competent to make the decision for a TOP.

    The US scan showed her to have a molar pregnancy.

    Molar pregancy is effectively a cancer generated from a failed pregnancy. It grows in the same way a tumour grows and requires (at the very least) a thorough surgical evacuation of uterus with lots of cautious follow-up but (at worst) can need drastic surgery and can cause death in just the same way that any other cancer can.

    She's 15

    Is she still Gillick competent or do you insist on phoning her mum?
    well this is a complex scenario on its own and the fact that the patient has a molar pregnancy adds to the complexity to this scenario.

    First, I would assess her capacity now after discovering she has a molar pregnancy. I would make her aware of the risks of the surgery and the follow up treatment. If i feel that she in incompetent and is not in the right frame of mind then I would act in her best interests this may be involving her parents or support workers. I think, on discovery she may feel that she now wants to discuss the situation with her mum because she has the chance of dying.
    The key is to re assess her capacity DONT assume she is competent and can give consent.
    Have a holistic approach, adding the label of cancer to something will terrify the patient and ensure you give her physiological and social support by referring her to the supplementary care of a counsellor.

    I think once you inform her of her molar pregnancy, she will be more inclined towards involving her parents. This is really a complex scenario and I think the way forward is assessing her capacity to give informed consent .
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    (Original post by Helenia)
    What do you think are the issues in this question?
    Well basically I was trying to come up with a question that would raise concerns with the GP about the medical student's comparability to medicine. But couldn't really think of a good situation where this may occur. Or in other words, what steps or how should the gp react in situation where they feel the student is not 'fit' for the future role of a doctor. Not specially to the lame example I gave but in general if a situation occurs. Of course the GP has to consider the welfare of others and whether the condition of the student is long term that could affect their duties as a doctor.
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    (Original post by SiMan)
    Well basically I was trying to come up with a question that would raise concerns with the GP about the medical student's comparability to medicine. But couldn't really think of a good situation where this may occur. Or in other words, what steps or how should the gp react in situation where they feel the student is not 'fit' for the future role of a doctor. Not specially to the lame example I gave but in general if a situation occurs. Of course the GP has to consider the welfare of others and whether the condition of the student is long term that could affect their duties as a doctor.
    So you're talking about Fitness to Practice, basically?

    Well, first of all you talk to the student and encourage them to seek support themselves from their university. You can discuss with them whether they think their medical condition will have a long-term detrimental effect on their ability to practice medicine, and what you and they can do about it. If they refuse to involve anyone else, then you would seek further legal advice and consider talking to their medical school/the GMC directly, but being very careful about what can/can't be said in terms of confidentiality. Most cases will never get that far though.
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    Ethical issues if you realise a fellow medical student is using illegal substances? Thanks guys
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    (Original post by Dr Gin)
    I have a 'Gillick Competence' thought for the day for you all: this was a real case experienced by one of my fellow med students back in our 4th year (More than 20 years ago but just as relevant today as then…)

    A 15 year old was referred to O+G requesting TOP (termination of pregnancy). She was only 8 or 9 weeks pregnant so it seemed like a 'reasonable' request with the only complication being that she insisted that her parents not be told anything about it. The Gynae team caring for her agreed that she was 'Gillick' competent and that she understood the risks of the procedure (medical TOP didn't exist back then so it was a surgical TOP with risks of ensuing infection, haemorrhage and infertility that were the issue) so she was scheduled for an ultrasound scan to confirm gestation, an appointment with a counsellor (to ensure that she was psychologically in a good place to make such a mammoth decision) and a social work team member (to ensure that she wasn't being sexually abused/pressured).

    What are your thoughts so far?

    Don't read the next bit, just imagine whether you might feel comfortable with the thought that this 15 year old is dealing with this on her own...

    OK, if you've committed your thoughts on the lat bit then read on...

    The social workers were happy; no concerns.

    The counsellor agreed that she was a sensible young thing without signs of any mental illness impairing her judgement they had no concerns about the assessment regarding her being Gillick competent to make the decision for a TOP.

    The US scan showed her to have a molar pregnancy.

    Molar pregancy is effectively a cancer generated from a failed pregnancy. It grows in the same way a tumour grows and requires (at the very least) a thorough surgical evacuation of uterus with lots of cautious follow-up but (at worst) can need drastic surgery and can cause death in just the same way that any other cancer can.

    She's 15

    Is she still Gillick competent or do you insist on phoning her mum?
    Yes I also agree with purple and gold. Her capacity should be reassessed after thoroughly telling her about her situation. Nevertheless if she still consents for the treatment and wishes her parents to be not involved, then her decision should be respected as she has autonomy. The consent of the patient is not a one off (as I just read from BMA ethics tool kit) but a continual process and if the are advancements/changes in the treatment or the problem then the patient is to be informed fully about consequences and consent to be made again after she is deemed competent according to fasers guidelines.
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    (Original post by Helenia)
    So you're talking about Fitness to Practice, basically?

    Well, first of all you talk to the student and encourage them to seek support themselves from their university. You can discuss with them whether they think their medical condition will have a long-term detrimental effect on their ability to practice medicine, and what you and they can do about it. If they refuse to involve anyone else, then you would seek further legal advice and consider talking to their medical school/the GMC directly, but being very careful about what can/can't be said in terms of confidentiality. Most cases will never get that far though.
    But of course if the GMC or the university require more information, then it should be permitted to an extent to what is needed. So the confidentiality is broken to a limit right?
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    (Original post by SiMan)
    But of course if the GMC or the university require more information, then it should be permitted to an extent to what is needed. So the confidentiality is broken to a limit right?
    It would have to be, but so far I can't find specific GMC guidance on the scenario. Hence treading very carefully and getting legal advice. I think as long as you know what issues arise in a case like this, knowing the actual answer (which is probably "it depends") is less important.
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    (Original post by Helenia)
    It would have to be, but so far I can't find specific GMC guidance on the scenario. Hence treading very carefully and getting legal advice. I think as long as you know what issues arise in a case like this, knowing the actual answer (which is probably "it depends") is less important.
    Ahh okay thanks.. hope they don't expect us to be really well informed on GMC guidelines and stuff like that. But a general answer like this seems reasonable.
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    (Original post by Dr Gin)
    I have a 'Gillick Competence' thought for the day for you all: this was a real case experienced by one of my fellow med students back in our 4th year (More than 20 years ago but just as relevant today as then…)

    A 15 year old was referred to O+G requesting TOP (termination of pregnancy). She was only 8 or 9 weeks pregnant so it seemed like a 'reasonable' request with the only complication being that she insisted that her parents not be told anything about it. The Gynae team caring for her agreed that she was 'Gillick' competent and that she understood the risks of the procedure (medical TOP didn't exist back then so it was a surgical TOP with risks of ensuing infection, haemorrhage and infertility that were the issue) so she was scheduled for an ultrasound scan to confirm gestation, an appointment with a counsellor (to ensure that she was psychologically in a good place to make such a mammoth decision) and a social work team member (to ensure that she wasn't being sexually abused/pressured).

    What are your thoughts so far?

    Don't read the next bit, just imagine whether you might feel comfortable with the thought that this 15 year old is dealing with this on her own...

    OK, if you've committed your thoughts on the lat bit then read on...

    The social workers were happy; no concerns.

    The counsellor agreed that she was a sensible young thing without signs of any mental illness impairing her judgement they had no concerns about the assessment regarding her being Gillick competent to make the decision for a TOP.

    The US scan showed her to have a molar pregnancy.

    Molar pregancy is effectively a cancer generated from a failed pregnancy. It grows in the same way a tumour grows and requires (at the very least) a thorough surgical evacuation of uterus with lots of cautious follow-up but (at worst) can need drastic surgery and can cause death in just the same way that any other cancer can.

    She's 15

    Is she still Gillick competent or do you insist on phoning her mum?
    This is actually really interesting from a purely intellectual point of view. I do feel sorry for the doctor and the team caring for her as well as the patient herself.

    One thing I do know is that Gillick competence scales with the severity of the scenario. So a 8 year old won't really have the capacity to consent for the removal of his genitals for example. So I would then re-asses her capacity to make such a decision as in does she have the competence, is not coerced and understands all the information put in front of her because now there is the chance of more serious complications and frequent revisits to hospital. I would strongly encourage the patient to speak to her parents about the situation and if I felt she did not have the capacity to make a informed decision then id contact a family member because I think confidentiality is not absolute especially if the patients life could be in danger.

    I would do what that doctor did and use help from my seniors and colleges to asses the patients capacity again. The psychologist and social workers. But I guess that is all you can do, if the patient does have the capacity then I guess you have to respect her wishes.
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    What you don't see on your work experience is all of the crazy laws/guidelines/competencies that doctors have to remember. It's like doing a Law degree on top of a medicine degree from the sounds of things, hahaha.

    Does anybody know any of the ethics surrounding Dementia patients and their treatment? If they begin treatment when they're lucid, then don't want any treatment when they aren't lucid (is there a word for not being lucid?), how do you deal with the situation? Is their next of kin responsible for their care? Not just curious about this because of interviews- at my care home voluntary work, quite often I get residents asking me how to get out and if I'll take them home... Any tips? The people at the care home said to just be honest and say 'you live here,' but sometimes that seems to confuse/upset them more!
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    (Original post by FlavaFavourFruit)
    Do you think the UKCAT is a good way to discriminate against students? If not, how would you go about selecting students for a medical interview?
    Lol I remember my career adviser asked me this many many many moons agooo.. I genuinely said make them do press ups !! Lol I thought I would share this and lighten everyone's mood lol do press ups do it do it now !!! No seriously ..... Do it ! Lolz


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