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

24 sample cards from the Professional Practice, Ethics and Leadership deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. What does a 95% confidence interval represent, and how does it relate to significance?

   A range within which the true population value is expected to lie with 95% confidence (if the study were repeated, 95% of such intervals would contain the true value). For a ratio (RR/OR), if the 95% CI crosses 1 the result is non-significant; for a difference, if it crosses 0 it is non-significant.

2. What is randomisation in an RCT and why is it important?

   The process of allocating participants to intervention or control groups by chance. It minimises selection bias and distributes known and unknown confounding factors evenly between groups, allowing causal inference about the intervention's effect.

3. Define blinding and distinguish single, double and triple blinding.

   Blinding conceals group allocation to reduce bias. Single-blind: participants are unaware of their allocation. Double-blind: participants and investigators/assessors are unaware. Triple-blind: participants, investigators, and the data analysts/outcome assessors are all unaware.

4. What is allocation concealment and how does it differ from blinding?

   Allocation concealment ensures the person enrolling participants cannot foresee the next assignment (preventing selection bias at the point of randomisation). Blinding occurs after allocation and keeps participants/investigators unaware of which treatment was given (preventing performance and detection bias).

5. What is intention-to-treat (ITT) analysis and why use it?

   Analysing participants in the groups to which they were originally randomised, regardless of whether they completed or adhered to the intervention. It preserves the benefits of randomisation, avoids attrition/non-compliance bias, and gives a pragmatic, conservative estimate of real-world effect.

6. Define confounding with an example.

   A confounder is a variable independently associated with both the exposure and the outcome, distorting the apparent relationship between them. Example: in studying coffee and lung cancer, smoking is a confounder because smokers tend to drink more coffee and smoking causes lung cancer.

7. What is the purpose of a CONSORT statement?

   CONSORT (Consolidated Standards of Reporting Trials) is a checklist and flow diagram providing standardised guidance for the transparent and complete reporting of randomised controlled trials, improving quality and reproducibility.

8. List the standard phases of clinical trials (Phase I-IV).

   Phase I: first-in-human, small group, assesses safety, dosing and pharmacokinetics. Phase II: assesses efficacy and side-effects in a larger group. Phase III: large RCT comparing with standard treatment for efficacy and safety (basis for licensing). Phase IV: post-marketing surveillance for long-term effects/rare adverse events.

9. What is the Declaration of Helsinki?

   A set of ethical principles developed by the World Medical Association (1964, regularly revised) governing medical research involving human subjects, emphasising informed consent, risk-benefit assessment, protection of vulnerable groups, and the primacy of the participant's wellbeing over scientific interests.

10. In the UK, what approvals are required before conducting research on NHS patients?

    Favourable opinion from a Research Ethics Committee (REC) via the Integrated Research Application System (IRAS), Health Research Authority (HRA) approval, and local NHS Trust R&D/capacity-and-capability confirmation. Clinical trials of medicines also need MHRA authorisation.

11. What are the four principles of surgical training described by Halsted, and the classic teaching adage?

    The Halstedian model: graded responsibility, repetition, close supervision within a hierarchy, and a scientific basis to practice. The classic adage is 'See one, do one, teach one,' now superseded by competency-based, simulation-supported progressive autonomy.

12. Describe Miller's pyramid of clinical competence.

    A four-level hierarchy of assessment: 'Knows' (knowledge) at the base, 'Knows how' (applied knowledge/competence), 'Shows how' (performance in a controlled setting, e.g. OSCE), and 'Does' (performance in real practice, e.g. workplace-based assessment) at the apex.

13. What does Kolb's experiential learning cycle consist of?

    Four stages: (1) Concrete Experience (doing), (2) Reflective Observation (reviewing the experience), (3) Abstract Conceptualisation (concluding/learning), (4) Active Experimentation (planning/trying out). Learning is most effective when the full cycle is completed.

14. Name common surgical workplace-based assessment (WBA) tools.

    PBA (Procedure-Based Assessment), DOPS (Direct Observation of Procedural Skills), CBD (Case-Based Discussion), Mini-CEX (Mini Clinical Evaluation Exercise), and MSF/360-degree multi-source feedback. Used to assess and document progression of competence.

15. What is Pendleton's model of feedback?

    A structured feedback method: (1) the learner states what went well, (2) the teacher states what went well, (3) the learner states what could be improved, (4) the teacher states what could be improved and how, ending with an action plan. It is positive-first and learner-led.

16. What is revalidation and how often does it occur for UK doctors?

    Revalidation is the process by which licensed doctors demonstrate to the GMC that they remain up to date and fit to practise, usually every five years. It is based on annual appraisals and a recommendation from the doctor's Responsible Officer.

17. What are the six types of supporting information required for medical appraisal/revalidation?

    (1) Continuing professional development (CPD); (2) Quality improvement activity (e.g. audit); (3) Significant events; (4) Feedback from patients; (5) Feedback from colleagues (MSF); (6) Review of complaints and compliments.

18. Define CPD (Continuing Professional Development) and its typical annual requirement.

    CPD is the continuing maintenance, development and broadening of a doctor's knowledge, skills and professional performance throughout their career. UK colleges typically require around 50 CPD credits/points per year (averaged over the appraisal cycle), with reflection on the learning.

19. What is a Responsible Officer (RO)?

    A senior doctor (usually the Medical Director) with a statutory role to oversee the conduct, performance and revalidation of doctors in their organisation, ensuring appraisals occur and making revalidation recommendations to the GMC.

20. Outline a structured approach to handling a patient complaint.

    Acknowledge promptly; listen and apologise (without necessarily admitting liability); investigate thoroughly and impartially; respond clearly with findings and any actions taken; offer learning and remedy; follow local NHS complaints procedure (with escalation to PHSO/Ombudsman if unresolved). Maintain candour throughout.

21. What is the 'second victim' phenomenon in patient safety?

    When a healthcare professional involved in an unanticipated adverse patient event, error or near-miss becomes traumatised, suffering psychological harm (guilt, anxiety, loss of confidence). Recognising and supporting the 'second victim' is important for staff wellbeing and a just safety culture.

22. What is a 'just culture' in clinical governance?

    An organisational culture that fairly distinguishes between human error, at-risk behaviour and reckless behaviour: it supports learning and openness rather than blame for honest mistakes and system failures, while still holding individuals accountable for willful misconduct or gross negligence.

23. What is situational awareness and why is it important in theatre safety?

    Situational awareness is the perception of elements in the environment, comprehension of their meaning, and projection of their future status (Endsley's three levels). Loss of situational awareness is a major contributor to surgical errors; maintaining it underpins effective decision-making and crisis management.

24. What are the 'five rights' of safe handover/care transfer?

    Originally the medication 'rights' (right patient, right drug, right dose, right route, right time) and in handover the principles of transferring the right information, about the right patient, to the right person, at the right time, with the right responsibility/accountability clearly assigned.

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