Fellowship of the Royal College of Surgeons (FRCS) Professional Practice, Ethics and Leadership Syllabus

Professional Practice, Ethics and Leadership syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Professional Practice, Ethics and Leadership in Fellowship of the Royal College of Surgeons (FRCS), not a summary of it.

1. 1

   Clinical Governance and Patient Safety

   5 topics

   • Audit and quality improvement
     • The audit cycle
     • PDSA methodology
   • Incident reporting and root cause analysis
     • Never events
     • Duty of candour
   • Human factors and theatre safety
     • WHO surgical safety checklist
     • Team communication and briefing
   • Morbidity and mortality review
   • Risk management and clinical governance frameworks
2. 2

   Medical Ethics and Law

   6 topics

   • Consent and capacity
     • Montgomery and informed consent
     • Mental Capacity Act and best interests
     • Consent in children (Gillick competence)
   • Confidentiality and information governance
   • End-of-life decisions and DNACPR
   • The four principles of biomedical ethics
   • Medical negligence and the Bolam/Bolitho tests
   • Death certification and the coroner
3. 3

   Communication and Teaching

   4 topics

   • Breaking bad news
   • Communication with colleagues and handover
     • SBAR structured handover
   • Principles of surgical education and training
     • Workplace-based assessments
     • Giving effective feedback
   • Managing the difficult conversation and complaints
4. 4

   Leadership, Management and Research

   5 topics

   • Leadership styles in healthcare
   • Evidence-based surgery and critical appraisal
     • Levels of evidence and hierarchy
     • Statistical concepts (p-values, confidence intervals)
     • Sensitivity, specificity and predictive values
   • Research methodology and trial design
     • Randomised controlled trials
     • Systematic review and meta-analysis
   • Research ethics and governance
   • Revalidation, appraisal and CPD

Professional Practice, Ethics and Leadership flashcards for Fellowship of the Royal College of Surgeons (FRCS)

19 of 77 cards from the Professional Practice, Ethics and Leadership deck — real questions with worked answers.

1. Define clinical audit and state the stages of the audit cycle.

   Clinical audit is a quality improvement process that measures current practice against explicit, evidence-based standards to improve patient care. The cycle: (1) identify problem/standard, (2) set criteria and standards, (3) collect data on current practice, (4) compare practice with standards, (5) implement change, (6) re-audit (close the loop).

2. What is the key distinction between clinical audit and research?

   Research seeks to generate new generalisable knowledge and discover the right thing to do (hypothesis-driven, may involve randomisation/placebo, needs ethics approval). Audit measures whether existing best practice is being followed against a known standard; it does not require formal research ethics approval.

3. Distinguish audit from a Quality Improvement (QI) project / PDSA cycle.

   Audit compares practice against a fixed standard at set points (a snapshot/closed loop). QI is a continuous, iterative process using small-scale tests of change. The PDSA cycle (Plan, Do, Study, Act) is the core QI tool, run repeatedly to refine an intervention.

4. List the seven pillars of clinical governance.

   (1) Clinical effectiveness and research, (2) Audit, (3) Risk management, (4) Education and training, (5) Patient and public involvement, (6) Using information (and IT), (7) Staffing and staff management. (Some frameworks add a focus on patient experience.)

5. Define clinical governance.

   The framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

6. What is a root cause analysis (RCA) and when is it triggered?

   RCA is a structured, retrospective investigation method used after a serious incident to identify the underlying systemic causes (not just immediate ones) and generate recommendations to prevent recurrence. Triggered by Serious Incidents (SIs), Never Events, or significant near-misses.

7. In incident reporting, define the difference between a near-miss, an adverse event, and a Never Event.

   Near-miss: an incident with potential to cause harm that was prevented before reaching the patient. Adverse event: an incident that resulted in harm to a patient. Never Event: a serious, largely preventable patient safety incident that should not occur if national safety recommendations are implemented (e.g. wrong-site surgery, retained instrument).

8. Give four examples of surgical Never Events.

   Wrong-site surgery, wrong implant/prosthesis, retained foreign object (e.g. swab or instrument) post-procedure, and wrong-route administration of medication. (Others: misplaced nasogastric tubes, wrong-patient procedures.)

9. What is the 'Swiss cheese model' of accident causation?

   Reason's model in which system defences are like slices of Swiss cheese: each layer has holes (latent and active failures). An accident occurs only when holes in successive layers align, allowing a hazard to pass through all defences to cause harm.

10. Distinguish active failures from latent conditions (Reason's model).

    Active failures: unsafe acts by people at the sharp end with immediate effect (slips, lapses, mistakes, violations). Latent conditions: hidden organisational/design weaknesses present in the system before the incident (poor staffing, faulty equipment, bad protocols) that predispose to error.

11. Define 'human factors' in the context of theatre safety.

    Human factors (ergonomics) is the study of the interrelationship between humans, the tools/equipment they use, and the environment, to optimise performance, safety and wellbeing. It addresses how design, teamwork, communication and cognition affect error in the operating theatre.

12. What are the three sections of the WHO Surgical Safety Checklist?

    (1) Sign In (before induction of anaesthesia), (2) Time Out (before skin incision), (3) Sign Out (before the patient leaves theatre).

13. What is the purpose of the SBAR tool and what does it stand for?

    SBAR is a structured communication tool to standardise handover and escalation. Situation, Background, Assessment, Recommendation.

14. List James Reason's classification of human error types.

    Errors split into: (1) Slips and lapses (skill-based errors of execution/memory), (2) Mistakes (rule-based or knowledge-based errors of planning), and separately (3) Violations (deliberate deviations from safe practice).

15. What is the purpose of a Morbidity and Mortality (M&M) meeting?

    A regular, confidential, non-punitive meeting reviewing deaths and complications to identify learning points, system errors and avoidable harm, promote education, and improve future patient care. It is reflective, not disciplinary.

16. What is the Clavien-Dindo classification used for?

    A standardised grading system for the severity of surgical complications based on the therapy required to treat them: Grade I (any deviation, no treatment), II (pharmacological treatment/blood/TPN), III (surgical/endoscopic/radiological intervention; IIIa no GA, IIIb under GA), IV (life-threatening, ICU; IVa single-organ, IVb multi-organ dysfunction), V (death).

17. State the four principles of biomedical ethics (Beauchamp and Childress).

    (1) Autonomy (respect the patient's right to self-determination), (2) Beneficence (act in the patient's best interest), (3) Non-maleficence ('first do no harm'), (4) Justice (fairness in distribution of resources and treatment).

18. What are the components of valid consent?

    Valid consent requires that the patient has capacity, is given sufficient information (including material risks and alternatives), and gives consent voluntarily (free from coercion).

19. State the four-stage functional test of capacity under the Mental Capacity Act 2005.

    A person lacks capacity if they cannot do one or more of: (1) understand the information relevant to the decision, (2) retain that information, (3) use or weigh it as part of the decision process, (4) communicate their decision (by any means).

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