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

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.

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.

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.

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.

What is an IMCA and when must one be instructed?

An Independent Mental Capacity Advocate — must be instructed for a person who lacks capacity, has no family or friends to consult, and faces a decision about serious medical treatment or a change in accommodation/long-stay hospital move.

Can a competent adult refuse life-saving treatment, and can their reasons be challenged?

Yes — a competent adult has an absolute right to refuse treatment, even if the refusal will result in their death, and they do not have to justify the decision; it can be for rational, irrational, or no reason at all.

What is an 'advance decision to refuse treatment' (ADRT) and when is it legally binding?

A decision made by a person with capacity to refuse specific treatment in the future should they lose capacity. It is legally binding if the person was 18+ and had capacity when made, it is valid and applicable to the situation, and — for refusal of life-sustaining treatment — it is written, signed and witnessed and states it applies even if life is at risk.

How is the refusal of treatment by a pregnant woman with capacity handled in UK law?

A competent pregnant woman may refuse treatment even if this risks harm to or the death of the fetus; the fetus has no legal personality before birth, so her autonomous refusal must be respected.

What does the 'Calgary-Cambridge' model structure in a clinical consultation?

It structures the medical interview into: initiating the session, gathering information, providing structure, building the relationship, explanation and planning, and closing the session — with building rapport and structuring running throughout.

What does the mnemonic ICE stand for in history taking, and why is it important?

Ideas, Concerns and Expectations — eliciting the patient's own understanding, worries and hopes for the consultation, which is central to patient-centred care and shared decision-making.

What does the SOCRATES mnemonic assess when taking a pain history?

Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/relieving factors, and Severity.

What is 'shared decision-making' and how does it differ from informed consent?

Shared decision-making is a collaborative process where clinician and patient together select tests/treatments based on evidence and the patient's values and preferences. Informed consent is the agreement that results; shared decision-making is the broader two-way deliberation that precedes it.

Name a widely-used protocol for breaking bad news and list its steps.

SPIKES: Setting up the interview, assessing Perception (what the patient already knows), obtaining the patient's Invitation (how much they want to know), giving Knowledge (warning shot then information in chunks), addressing Emotions with empathy, and Strategy/Summary (plan and follow-up).

What is a 'warning shot' when breaking bad news?

A brief preparatory statement that alerts the patient that difficult news is coming (e.g. 'I'm afraid I have some serious news to discuss'), giving them a moment to prepare emotionally before the information is delivered.

How should a doctor respond to a patient's relative who asks them to withhold a diagnosis from the patient (collusion)?

Explore the relative's concerns empathetically, but explain you cannot lie to a patient who wishes to know; a competent patient has the right to information about their own health. Find out how much the patient actually wants to know rather than assuming.

How should a clinician approach an angry patient in a challenging consultation?

Stay calm and non-defensive, acknowledge and validate the emotion, listen actively, avoid arguing, apologise where appropriate, ensure personal safety, and try to identify and address the underlying concern.

How should a clinician respond when a patient discloses something prefaced by 'don't tell anyone, but...'?

Do not promise unconditional confidentiality; explain gently that you usually keep information confidential but may have to share it if there is a risk of serious harm to them or others, so that the patient can decide what to disclose.

What is the 'Swiss cheese model' of patient safety?

James Reason's model in which system defences are like slices of cheese with holes (latent and active failures); an incident occurs only when the holes momentarily align, allowing a hazard to pass through all layers. It promotes a systems approach rather than blaming individuals.

Distinguish a 'near miss', an 'adverse event', and a 'never event' in patient safety.

Near miss: an error that was caught before reaching the patient. Adverse event: an injury caused by medical management rather than the underlying disease. Never event: a serious, largely preventable patient safety incident that should never occur if proper barriers are in place (e.g. wrong-site surgery).

Give three examples of 'never events' in healthcare.

Wrong-site surgery, retained foreign object after a procedure, and wrong-route administration of medication (e.g. intravenous administration of a drug intended for the intrathecal/oral route). Others include mismatched blood transfusion and misplaced naso/orogastric tubes.

What is the recommended structured tool for clinical handover and what does it stand for?

SBAR: Situation (what is happening now), Background (relevant context/history), Assessment (what you think the problem is), and Recommendation (what you want done/need).

State the core medico-legal rule about documentation in clinical records.

Records must be clear, accurate, legible, contemporaneous (made at the time or as soon as possible), and signed/dated/timed — 'if it isn't documented, it didn't happen'. Never falsify or retrospectively alter records to mislead.

How should an error in a written clinical note be corrected?

Put a single line through the error so the original remains legible, write the correction, and sign, date and time the amendment — never obliterate, erase, or use correction fluid over the original entry.

What are Tuckman's stages of team development?

Forming, Storming, Norming, Performing — and later Adjourning (Mourning), describing how a team comes together, works through conflict, settles into roles, and reaches effective performance.

What is a 'human factors' approach to working in teams and safety?

It examines how human capabilities and limitations, environment, equipment design, and team communication affect performance, aiming to design systems that reduce error and support safe behaviour rather than blaming individuals.

What is a 'safety huddle' in a clinical team?

A brief, regular (often daily) multidisciplinary meeting to proactively share information about patient safety risks, sick or deteriorating patients, staffing, and workload, so the team can act early to prevent harm.

Under the Care Act 2014, what are the six key principles of adult safeguarding?

Empowerment, Prevention, Proportionality, Protection, Partnership, and Accountability.

Who is a 'safeguarding adult at risk' under the Care Act 2014?

An adult (18+) who has needs for care and support (whether or not currently met), is experiencing or at risk of abuse or neglect, and as a result of their care needs is unable to protect themselves against the abuse, neglect or risk of it.

List the main categories of abuse recognised in adult safeguarding.

Physical, psychological/emotional, sexual, financial/material, neglect and acts of omission, discriminatory, organisational/institutional, domestic, modern slavery, self-neglect, and (now) coercive control.

What is 'Making Safeguarding Personal' (MSP)?

The principle that safeguarding responses should be person-led and outcome-focused — engaging the adult, understanding what they want to achieve, respecting their wishes and capacity, rather than a purely process-driven intervention.

What immediate actions should a clinician take on identifying a safeguarding concern about an adult at risk?

Ensure the person's immediate safety and medical needs, treat any injuries, document findings accurately and objectively, gain consent to share where possible (but share without consent if there is risk of serious harm or to others), and refer to the local safeguarding lead/adult social care, contacting police if a crime is suspected.