Professional and Linguistic Assessments Board (PLAB) Professional Practice, Ethics and Communication Syllabus

Professional Practice, Ethics and Communication 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 Communication in Professional and Linguistic Assessments Board (PLAB), not a summary of it.

1. 1

   Good Medical Practice and Ethics

   4 topics

   • GMC Duties of a Doctor
     • Four domains of Good Medical Practice
     • Maintaining trust and probity
   • Ethical Principles
     • Autonomy, beneficence, non-maleficence and justice
     • Ethical dilemmas and decision-making
   • Confidentiality
     • Disclosure with and without consent
     • Public interest disclosures
   • Raising Concerns and Duty of Candour
     • Whistleblowing
     • Being open after errors
2. 2

   Consent and Capacity

   4 topics

   • Valid Consent
     • Information disclosure and Montgomery
     • Voluntariness
   • Assessing Capacity
     • Two-stage capacity test
     • Fluctuating capacity
   • Consent in Special Groups
     • Children and young people
     • Adults lacking capacity
   • Refusal of Treatment
     • Advance decisions
     • Lasting power of attorney
3. 3

   Clinical Communication Skills

   4 topics

   • History Taking
     • Structured history and presenting complaint
     • Ideas, concerns and expectations
   • Explanation and Shared Decision-Making
     • Explaining diagnoses and procedures
     • Negotiating management plans
   • Breaking Bad News
     • SPIKES framework
     • Responding to emotion
   • Challenging Consultations
     • Angry or distressed patients
     • Cross-cultural and interpreter consultations
4. 4

   Patient Safety and Teamworking

   4 topics

   • Patient Safety
     • Error, near-miss and incident reporting
     • Root cause analysis
   • Handover and Documentation
     • SBAR communication
     • Accurate record keeping
   • Working in Teams
     • Multidisciplinary working
     • Escalation and seeking help
   • Safeguarding Adults
     • Recognising abuse and neglect
     • Referral and protection

Professional Practice, Ethics and Communication flashcards for Professional and Linguistic Assessments Board (PLAB)

24 of 51 cards from the Professional Practice, Ethics and Communication deck — real questions with worked answers.

1. What are the four domains of the GMC's 'Good Medical Practice' framework that define a doctor's professional duties?

   Domain 1: Knowledge, skills and development (provide good clinical care). Domain 2: Patients, partnership and communication. Domain 3: Colleagues, culture and safety. Domain 4: Trust and professionalism (maintaining honesty and integrity).

2. According to GMC 'Duties of a Doctor', what must always be a doctor's first concern?

   To make the care of the patient the first concern, treating patients as individuals and respecting their dignity, autonomy and right to confidentiality.

3. What are the four pillars (principles) of medical ethics described by Beauchamp and Childress?

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

4. Define the ethical principle of 'non-maleficence'.

   The obligation to avoid causing harm to the patient — 'primum non nocere' (first, do no harm) — including weighing the risks of an intervention against its benefits.

5. What is the difference between 'beneficence' and 'paternalism' in medical ethics?

   Beneficence is acting in the patient's best interests while respecting their autonomy; paternalism is overriding a competent patient's autonomous choices on the grounds that the doctor knows what is best for them.

6. In medical ethics, what does the principle of 'justice' require of a doctor?

   Fair and equitable treatment of patients — fair distribution of scarce resources, respect for the law and people's rights, and non-discrimination.

7. What is the general GMC rule on patient confidentiality?

   Information that patients share is confidential and must not be disclosed without consent, except where required by law, in the public interest, or to protect the patient or others from serious harm.

8. List the main circumstances in which a doctor may lawfully breach confidentiality without patient consent.

   When required by law/statute (e.g. notifiable diseases), when ordered by a court, when the patient consents, and when disclosure is justified in the public interest to prevent serious harm to the patient or others.

9. Name three examples of disclosures 'required by law' that override confidentiality.

   Notifiable infectious diseases (Public Health Act), notification of births and deaths, and reporting under the Road Traffic Act (e.g. identifying a driver), plus reporting to the police certain gunshot/knife wounds and terrorism concerns.

10. Does the duty of confidentiality continue after a patient has died?

    Yes — the ethical and legal duty of confidentiality continues after death, though some disclosures may be permitted (e.g. to a coroner, for death certification, or under the Access to Health Records Act 1990).

11. What is the 'duty of candour' and when is it triggered?

    The professional and statutory duty to be open and honest with patients when something goes wrong with their care. It is triggered when a patient suffers (or could suffer) harm or distress as a result of their care — the patient must be told what happened, given an apology, and offered remedy/support.

12. What are the key steps a doctor must take to fulfil the duty of candour after a patient safety incident?

    Tell the patient (or relative) what happened promptly, offer an apology, explain the short and long-term effects, and report the incident appropriately so lessons can be learned.

13. What is the recommended escalation pathway when 'raising concerns' about patient safety in the NHS?

    First raise locally with the immediate manager/clinical lead or supervisor; if unresolved, escalate to a senior manager, named/Freedom to Speak Up Guardian, or medical director; if still unresolved, escalate externally to a regulator (GMC, CQC) — never stay silent if patients are at risk.

14. What legal protection exists for NHS staff who 'blow the whistle' about patient safety?

    The Public Interest Disclosure Act 1998 protects workers who make 'protected disclosures' in the public interest from detriment or dismissal.

15. What three elements must all be present for consent to be legally valid?

    The patient must have capacity to decide, must have sufficient information (be informed), and must give consent voluntarily (without coercion or undue influence).

16. Following the Montgomery v Lanarkshire (2015) ruling, what standard governs the disclosure of risks during consent?

    Doctors must disclose any 'material risk' — a risk to which a reasonable person in the patient's position would attach significance, or that this particular patient would attach significance to — replacing the older paternalistic Bolam standard for consent/information.

17. Does valid consent always have to be written?

    No — consent can be verbal, written or implied (non-verbal). Written consent is best practice for significant interventions or those with notable risks, but a signed form is only evidence of the consent process, not consent itself.

18. What are the five statutory principles of the Mental Capacity Act 2005?

    1) Assume capacity unless proven otherwise. 2) Support the person to make their own decision before deeming them unable. 3) An unwise decision does not mean lack of capacity. 4) Act in the person's best interests if they lack capacity. 5) Choose the least restrictive option of their rights and freedoms.

19. What is the two-stage test for assessing capacity under the Mental Capacity Act 2005?

    Stage 1 (diagnostic): Is there an impairment of, or disturbance in, the functioning of the mind or brain? Stage 2 (functional): Does that impairment mean the person is unable to make the specific decision at this time?

20. What four abilities must a person demonstrate to be deemed to have decision-making capacity (functional test)?

    The person must be able to: 1) Understand the information relevant to the decision, 2) Retain that information, 3) Use or weigh it as part of the decision process, and 4) Communicate their decision (by any means).

21. Is capacity 'all or nothing' or is it decision- and time-specific?

    Capacity is decision-specific and time-specific — a person may have capacity for one decision but not another, and capacity can fluctuate over time, so it must be assessed for each decision when it needs to be made.

22. At what age is a person presumed to have capacity to consent to treatment in England and Wales, and what about 16-17 year olds?

    Adults aged 18+ are presumed competent. Those aged 16-17 are presumed to have capacity to consent to treatment (Family Law Reform Act 1969), though a refusal can sometimes be overridden by a person with parental responsibility or the court.

23. What is 'Gillick competence' and the related 'Fraser guidelines'?

    Gillick competence: a child under 16 may consent to their own treatment if they have sufficient maturity and intelligence to fully understand what is proposed. Fraser guidelines specifically apply to giving contraceptive/sexual health advice to under-16s without parental consent.

24. Who can make decisions for an adult who lacks capacity, and on what basis?

    Decisions are made in the patient's 'best interests' by the treating clinician, considering the person's past wishes, beliefs and values, and consulting family/carers, a Lasting Power of Attorney (health & welfare), a court-appointed deputy, or an IMCA if the person is unbefriended.

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