Looking forward to this important #Webinar
Live tweets in thread to folllow, followed by a summary of key points on completion of Webinar
Credit to: @PLASTAUK @Canniesburn
Live tweets in thread to folllow, followed by a summary of key points on completion of Webinar
Credit to: @PLASTAUK @Canniesburn
https://twitter.com/Canniesburn/status/1258390443982798848
1/
Speaker: @narkoulis
Structure:
- exam format and ethics station
- how to get high mark s
- strategy for answering questions
- interactive scenarios
Speaker: @narkoulis
Structure:
- exam format and ethics station
- how to get high mark s
- strategy for answering questions
- interactive scenarios
2/
Exam Format:
Day 1: clinical (32 marks -Performance in clinical is generally poorer than the viva)
Day 2: vivas (more marks - 36 marks)
Ethics & Consent (a big focus) is the 3rd oral station (in same station as sciences, aesthetics)
Ethics is a "marginal gains station"
Exam Format:
Day 1: clinical (32 marks -Performance in clinical is generally poorer than the viva)
Day 2: vivas (more marks - 36 marks)
Ethics & Consent (a big focus) is the 3rd oral station (in same station as sciences, aesthetics)
Ethics is a "marginal gains station"
3/
Ethics Station
2 Ethics Questions x 2 marks = 4 marks
Difficult to fail if answering sensibly
JCIE has a guideline document on how to do well.
3 important factors:
1. higher-order thinking
2. no prompting
3. supporting evidence and knowledge of literature
Ethics Station
2 Ethics Questions x 2 marks = 4 marks
Difficult to fail if answering sensibly
JCIE has a guideline document on how to do well.
3 important factors:
1. higher-order thinking
2. no prompting
3. supporting evidence and knowledge of literature
4/
Strategy in Answers in 3 steps:
1. Legal: What does law say? Higher marks will quote statue, case law
2. Medical: what medical implications will your decisions have? Higher marks for quoting papers
3. Ethical: What is good medical practice in this case? Quote Guidelines
Strategy in Answers in 3 steps:
1. Legal: What does law say? Higher marks will quote statue, case law
2. Medical: what medical implications will your decisions have? Higher marks for quoting papers
3. Ethical: What is good medical practice in this case? Quote Guidelines
5/
Scenario 1: 16F, BBA, with mum
1. Legal: >16 = diff. legal domain. Age of legal capacity in Scotland, the Family Law Reform Act in England & Wales, Age of Majority Act 1969, Non-Fatal Offenses against the Person Act (Ireland)
(more than just Gillick - statue > case law)
Scenario 1: 16F, BBA, with mum
1. Legal: >16 = diff. legal domain. Age of legal capacity in Scotland, the Family Law Reform Act in England & Wales, Age of Majority Act 1969, Non-Fatal Offenses against the Person Act (Ireland)
(more than just Gillick - statue > case law)
6/
Scenario 1: 16F, BBA, with mum
2. Medical aspects: Biopsychosocial model, quote papers
Scenario 1: 16F, BBA, with mum
2. Medical aspects: Biopsychosocial model, quote papers
7/
Scenario 1: 16F, BBA, with mum
3. Good Medical Practice: BAAPS Guidlines >18, FDA for >18 for slaine and >21 for silicone
(legal and medically okay, but not always good medical practice - needs to tick all boxes)
Scenario 1: 16F, BBA, with mum
3. Good Medical Practice: BAAPS Guidlines >18, FDA for >18 for slaine and >21 for silicone
(legal and medically okay, but not always good medical practice - needs to tick all boxes)
8/
Scenario 2: 14M, Hand, Father refuses consent
1. Legal: Age Legal Capacity in Scot, E/W/NI: Gillick vs West Norfolk
<16 have capacity to consent, depends on maturity + ability to understand
Lowest age: >12 may have views on Tx (in S), E/W/NI: no lower limit in Gillick
Scenario 2: 14M, Hand, Father refuses consent
1. Legal: Age Legal Capacity in Scot, E/W/NI: Gillick vs West Norfolk
<16 have capacity to consent, depends on maturity + ability to understand
Lowest age: >12 may have views on Tx (in S), E/W/NI: no lower limit in Gillick
9/
Scenario 2: 14M, Hand, Father refuses consent
2. Medical Aspects: discuss evidence
Scenario 2: 14M, Hand, Father refuses consent
2. Medical Aspects: discuss evidence
10/
Scenario 2: 14M, Hand, Father refuses consent
3/. GMP: Respect the child's autonomy. GMC guidance on 0-18 consent. Take extra steps to discuss concerns with father and try to locate mother
Scenario 2: 14M, Hand, Father refuses consent
3/. GMP: Respect the child's autonomy. GMC guidance on 0-18 consent. Take extra steps to discuss concerns with father and try to locate mother
11/
Scenario 3: 15M, MM on Nose, Refused WLE
1. Legal:
Scot - competent childs refusal no be overridden. Child Act 1955 - 12 or more, presumed to be sufficient
E/W/NI: minors' refusal can be overridden. Law (1992, 1993) criticized
Ireland: No definitive framework
Scenario 3: 15M, MM on Nose, Refused WLE
1. Legal:
Scot - competent childs refusal no be overridden. Child Act 1955 - 12 or more, presumed to be sufficient
E/W/NI: minors' refusal can be overridden. Law (1992, 1993) criticized
Ireland: No definitive framework
12/
Scenario 3: 15M, MM on Nose, Refused WLE
2. Medical: Discuss Evidence
Scenario 3: 15M, MM on Nose, Refused WLE
2. Medical: Discuss Evidence
13/
Scenario 3: 15M, MM on Nose, Refused WLE
3. GMP Guidance on 0-18y (Para 31): if a patient continues to refuse, seek legal advice. Respect child's autonomy, assess family dynamic, involve clinical psychology, multiple sessions
Scenario 3: 15M, MM on Nose, Refused WLE
3. GMP Guidance on 0-18y (Para 31): if a patient continues to refuse, seek legal advice. Respect child's autonomy, assess family dynamic, involve clinical psychology, multiple sessions
14/
Scenario 4: 7F, Prominent Ear, mum consents & dad refused (divorced)
1. Legal: Who has parental responsibility?
Children's/Gaurian Acts of UK - mother gets it auto, father if married at birth or subsequently.
Ireland: Mum auto, unmarried fathers position not so certain
Scenario 4: 7F, Prominent Ear, mum consents & dad refused (divorced)
1. Legal: Who has parental responsibility?
Children's/Gaurian Acts of UK - mother gets it auto, father if married at birth or subsequently.
Ireland: Mum auto, unmarried fathers position not so certain
15/
Scenario 4: 7F, Prominent Ear, mum consents & dad refused (divorced)
1. Legal: How many parents for consent?
Usually one is enough even if the other disagrees, but there are exception where both must consent or court order sought: circumcision, vaccinations
Scenario 4: 7F, Prominent Ear, mum consents & dad refused (divorced)
1. Legal: How many parents for consent?
Usually one is enough even if the other disagrees, but there are exception where both must consent or court order sought: circumcision, vaccinations
16/
Scenario 4: 7F, Prominent Ear, mum consents & dad refused (divorced)
2. Medical Aspect: Discuss evidence
Scenario 4: 7F, Prominent Ear, mum consents & dad refused (divorced)
2. Medical Aspect: Discuss evidence
17/
Scenario 4: 7F, Prominent Ear, mum consents & dad refused (divorced)
3. GMP: GMC + BMA + Dept. of Health Guidance.
Performing cosmetic non-necessary intervention in immature minor when parent disagreement is not good medical practice, would not stand up yo legal scrutiny
Scenario 4: 7F, Prominent Ear, mum consents & dad refused (divorced)
3. GMP: GMC + BMA + Dept. of Health Guidance.
Performing cosmetic non-necessary intervention in immature minor when parent disagreement is not good medical practice, would not stand up yo legal scrutiny
18/
Scenario 5: 35M, controlled schizophrenia, refuses surgery for nec fasc.
1. Legal:
Scot - MHA for emergency detention, Adults with Incapacity Act for Tx admin
E/W - Mental Health & Capacity Acts
NI: Mental Capacity Act
Legal precedent: Re C 1994, 1WLR290 - NB!!
Scenario 5: 35M, controlled schizophrenia, refuses surgery for nec fasc.
1. Legal:
Scot - MHA for emergency detention, Adults with Incapacity Act for Tx admin
E/W - Mental Health & Capacity Acts
NI: Mental Capacity Act
Legal precedent: Re C 1994, 1WLR290 - NB!!
19/
Scenario 5: 35M, controlled schizophrenia, refuses surgery for nec fasc.
2. Medical Aspects: Discuss evidence and treatment pathways/options
Scenario 5: 35M, controlled schizophrenia, refuses surgery for nec fasc.
2. Medical Aspects: Discuss evidence and treatment pathways/options
20/
Scenario 5: 35M, controlled schizophrenia, refuses surgery for nec fasc.
3. GMP - if you & colleagues deem this patient to have the capacity, have to respect autonomy & wishes. work on presumption that all adult patient has capacity. Involve senior colleagues +/- courts
Scenario 5: 35M, controlled schizophrenia, refuses surgery for nec fasc.
3. GMP - if you & colleagues deem this patient to have the capacity, have to respect autonomy & wishes. work on presumption that all adult patient has capacity. Involve senior colleagues +/- courts
21/
Scenario 6: Patient confidentiality
1. Legal: Breach of confidentially is allowed (and sometimes required) if there is overriding public interest. A legal minefield - Crime and Disorder Act 1988 (pan-UK), Caldicott Guardians, Adult Support and Protection Act 2007 (Scot)
Scenario 6: Patient confidentiality
1. Legal: Breach of confidentially is allowed (and sometimes required) if there is overriding public interest. A legal minefield - Crime and Disorder Act 1988 (pan-UK), Caldicott Guardians, Adult Support and Protection Act 2007 (Scot)
22/
Scenario 6: Patient confidentiality
2. Medical: Dicusss management
Scenario 6: Patient confidentiality
2. Medical: Dicusss management
23/
Scenario 6: Patient confidentiality
GMC Guidance on Confidentiality.
It would be reasonable to assist the police. If the victim could consent, reasonable to assume that they would do so. There is clear public interest in allowing the police to investigate.
Scenario 6: Patient confidentiality
GMC Guidance on Confidentiality.
It would be reasonable to assist the police. If the victim could consent, reasonable to assume that they would do so. There is clear public interest in allowing the police to investigate.
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