UK Medical Licensing Assessment (UKMLA) Professional Knowledge, Ethics and the Practising Doctor Syllabus

Professional Knowledge, Ethics and the Practising Doctor syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Professional Knowledge, Ethics and the Practising Doctor in UK Medical Licensing Assessment (UKMLA), not a summary of it.

1. 1

   Professional Values and Behaviours

   4 topics

   • Good Medical Practice duties of a doctor
     • Knowledge, skills and performance
     • Safety and quality
     • Communication, partnership and teamwork
     • Maintaining trust and integrity
   • Professional identity and the doctor-patient relationship
     • Trust, honesty and acting with integrity
     • Maintaining professional boundaries
     • Conflicts of interest and accepting gifts
   • Maintaining and demonstrating competence
     • Recognising and working within the limits of competence
     • Appraisal, revalidation and continuing professional development
     • Keeping accurate clinical records
   • Health, wellbeing and fitness to practise of the doctor
     • Managing stress, burnout and fatigue
     • Self-treatment and registering with a GP
     • Bloodborne virus and notifiable illness obligations
2. 2

   Medical Ethics and the Law

   6 topics

   • Core ethical principles and frameworks
     • Autonomy, beneficence, non-maleficence and justice
     • Duty-based and consequentialist reasoning
     • Distributive justice and resource allocation
   • Confidentiality and information governance
     • Duty of confidentiality and its limits
     • Disclosures in the public interest
     • Data protection and Caldicott principles
     • Statutory disclosures and notifiable diseases
   • Consent to treatment
     • Valid consent: capacity, information and voluntariness
     • Montgomery and the standard for material risk
     • Consent in emergencies and the doctrine of necessity
     • Refusal of treatment and advance decisions
   • Mental capacity and decision-making
     • Mental Capacity Act 2005 and the two-stage test
     • Best interests decisions
     • Lasting power of attorney and court-appointed deputies
     • Deprivation of Liberty Safeguards
   • End-of-life ethics
     • Withholding and withdrawing treatment
     • Do Not Attempt CPR decisions and ReSPECT
     • Doctrine of double effect
     • Euthanasia and assisted dying: the legal position
   • Consent and capacity in children
     • Gillick competence and Fraser guidelines
     • Parental responsibility and disputes
     • Refusal of treatment by minors
3. 3

   Safeguarding and Vulnerable Groups

   5 topics

   • Safeguarding children
     • Recognising physical, emotional and sexual abuse and neglect
     • Fabricated or induced illness
     • Referral pathways and information sharing
   • Safeguarding adults at risk
     • Types of adult abuse including financial and institutional
     • Domestic abuse and coercive control
     • Modern slavery and human trafficking
   • Female genital mutilation
     • Mandatory reporting duty
     • Risk assessment and referral
   • Radicalisation and the Prevent duty
   • Recognising and responding to deprivation and inequality
4. 4

   Patient Safety, Quality Improvement and Governance

   5 topics

   • Human factors and systems thinking in error
     • Swiss cheese model and latent errors
     • Never events
     • Situational awareness and cognitive bias
   • Incident reporting and learning
     • Duty of candour
     • Significant event analysis and root cause analysis
     • Open disclosure and apology
   • Quality improvement methodology
     • Plan-Do-Study-Act cycles
     • Clinical audit versus research versus service evaluation
     • Measurement for improvement and run charts
   • Clinical governance and regulation
     • Roles of the CQC, GMC and NICE
     • Whistleblowing and raising concerns
     • Risk management and the safety thermometer
   • Medication safety and prescribing errors
5. 5

   Evidence-Based Medicine and Research

   4 topics

   • Study design and hierarchy of evidence
     • Randomised controlled trials, cohort and case-control studies
     • Systematic reviews and meta-analysis
     • Bias, confounding and randomisation
   • Critical appraisal and statistics
     • Sensitivity, specificity and predictive values
     • Relative and absolute risk, NNT and odds ratios
     • P-values, confidence intervals and statistical power
   • Screening principles
     • Wilson and Jungner criteria
     • Lead-time and length-time bias
     • National screening programmes
   • Research ethics and governance
     • Informed consent in research
     • Research ethics committees and the Declaration of Helsinki
     • Conflicts of interest in publication
6. 6

   Public Health and Health Promotion

   4 topics

   • Determinants of health and health inequalities
     • Social, economic and environmental determinants
     • Inverse care law
     • Health needs assessment
   • Epidemiology of disease
     • Incidence, prevalence and mortality measures
     • Outbreak investigation
     • Surveillance and notifiable diseases
   • Health behaviour change and promotion
     • Brief interventions and motivational interviewing
     • Smoking cessation, alcohol and weight management
     • Immunisation principles and the UK schedule
   • Global and environmental health
     • Climate change and sustainable healthcare
     • Antimicrobial resistance as a public health threat

Professional Knowledge, Ethics and the Practising Doctor flashcards for UK Medical Licensing Assessment (UKMLA)

21 of 63 cards from the Professional Knowledge, Ethics and the Practising Doctor deck — real questions with worked answers.

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

   1) Knowledge, skills and development (formerly 'Knowledge, skills and performance'); 2) Patients, partnership and communication; 3) Colleagues, culture and safety; 4) Trust and professionalism.

2. According to Good Medical Practice, what overriding principle must guide a doctor's clinical decisions?

   Make the care of your patient your first concern. The doctor must act in the patient's best interests, provide a good standard of practice and care, and protect and promote the health of patients and the public.

3. What is meant by 'professionalism' and the formation of a professional identity in medicine?

   It is the internalisation of the values, behaviours and relationships that underpin public trust in doctors — acting with integrity, honesty, compassion and accountability — so that one thinks, acts and feels like a physician, not just performs the role.

4. What is the duty of candour, and distinguish its professional and statutory forms?

   The duty to be open and honest with patients when something goes wrong. Professional duty of candour (GMC/NMC) applies to individuals for any harm or near miss; statutory duty (Health and Social Care Act 2008, Reg 20) applies to organisations and is triggered by a notifiable safety incident causing moderate/severe harm, prolonged psychological harm, or death.

5. How must a doctor maintain and demonstrate competence under GMC requirements?

   By keeping knowledge and skills up to date through continuing professional development (CPD), working within the limits of competence, taking part in annual appraisal, collecting supporting information, and undergoing revalidation every 5 years to retain a licence to practise.

6. What are the components of GMC revalidation in the UK?

   A licensed doctor revalidates every 5 years based on annual appraisals supported by: CPD, quality improvement activity, significant events, feedback from colleagues, feedback from patients, and review of complaints and compliments. A Responsible Officer makes the revalidation recommendation.

7. What should a doctor do regarding their own health if they may pose a risk to patients (fitness to practise)?

   Register with a GP, not self-diagnose or self-prescribe, seek and follow independent professional advice, and not rely on their own assessment of the risk. If they have a serious condition that could be passed to patients, they must take advice and act on it to protect patients.

8. Define 'fitness to practise' as used by the GMC.

   A doctor's suitability to be on the medical register without restrictions. It can be impaired by misconduct, deficient performance, ill health, a criminal conviction/caution, or a determination by another regulatory body.

9. Name the four core principles ('four pillars') of biomedical ethics (Beauchamp and Childress).

   Autonomy (respect for self-determination), Beneficence (act in the patient's best interest), Non-maleficence (do no harm), and Justice (fair distribution of benefits, risks and resources).

10. Contrast deontological and consequentialist (utilitarian) ethical frameworks.

    Deontology judges acts by adherence to duties/rules and the inherent rightness of the act regardless of outcome (e.g. never lie). Consequentialism judges acts by their outcomes, aiming to maximise overall good (the greatest good for the greatest number).

11. What is the doctrine of double effect?

    An action with a good intended effect (e.g. relieving pain) may be permissible even if it has a foreseen but unintended harmful effect (e.g. hastening death), provided the harmful effect is not the means to the good effect, the act is proportionate, and the intention is good.

12. State the general legal and ethical rule on patient confidentiality and its main justifications.

    Information shared in confidence must not be disclosed without consent. Justified by respect for autonomy, the implied contract of the doctor-patient relationship, and the public interest in patients trusting doctors enough to seek care.

13. List circumstances in which a doctor may disclose confidential patient information without consent.

    When required by law/statute (e.g. notifiable diseases, FGM in under-18s, court order), and when justified in the public interest where the benefit (preventing serious harm/crime) outweighs the patient's and public interest in confidentiality. Disclosure should be the minimum necessary.

14. What are the Caldicott Principles concerned with, and name the role that safeguards them?

    They govern the use and sharing of confidential patient/service-user information (e.g. justify the purpose, use the minimum necessary, access on a need-to-know basis, and that the duty to share can be as important as the duty to protect). The Caldicott Guardian is the senior person responsible for protecting patient information in an organisation.

15. Under UK GDPR/Data Protection Act 2018, what is the lawful basis category for health data and who can access records?

    Health data is 'special category' personal data requiring an additional condition (e.g. provision of health care, vital interests). Patients have a right of access (subject access request) to their own records, and access must follow the data protection principles (lawfulness, minimisation, accuracy, security).

16. What three elements must all be present for consent to treatment to be valid?

    1) Capacity (the patient is able to make the decision); 2) Voluntariness (the decision is free from coercion or undue influence); 3) Information (the patient is given sufficient, relevant information). Consent must be ongoing and can be withdrawn.

17. What standard of information disclosure for consent was established by Montgomery v Lanarkshire (2015)?

    Doctors must disclose any material risks — those a reasonable person in the patient's position would attach significance to, or that this particular patient would. It replaced the doctor-centred Bolam test for consent with a patient-centred standard of material risk.

18. State the five principles of the Mental Capacity Act 2005 (England and Wales).

    1) Presume capacity. 2) Support people to make their own decisions before deeming them unable. 3) An unwise decision does not equal 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 mental capacity under the MCA 2005?

    Stage 1 (diagnostic): Is there an impairment of, or disturbance in, the functioning of the mind or brain? Stage 2 (functional): Because of it, is the person unable to do one of: Understand the information, Retain it, Use/weigh it, or Communicate the decision? Capacity is decision- and time-specific.

20. What is an Advance Decision to Refuse Treatment (ADRT) and what is required for it to refuse life-sustaining treatment?

    A legally binding decision made by a person with capacity to refuse specified treatment in future when they lack capacity. To refuse life-sustaining treatment it must be in writing, signed, witnessed, and contain a clear statement that it applies even if life is at risk.

21. Distinguish a Lasting Power of Attorney for health from best-interests decision-making.

    A health and welfare LPA lets a chosen attorney make decisions (including, if specified, about life-sustaining treatment) once the person loses capacity. Without a valid ADRT or LPA, the clinical team makes a best-interests decision considering the person's past wishes, feelings, beliefs and the views of those close to them.

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