Anthony, a final year medical student is on placement at a geriatric ward in the local hospital.

It is
approaching 5pm and he is getting ready to leave. The night shift doctor, Dr Randall, comes in
smelling strongly of alcohol.

How important to take into account are the following considerations for Anthony when deciding
how to respond to this situation?

Dr Randall's reputation:

Even if Dr Randall is a top doctor, it is important to raise issues that are likely to impact patient care.
However, his reputation may be damaged and that may lead to patients having less trust in the
healthcare system and the reputation of doctors as a whole so it is of minor importance.

The risk of patient care being compromised if Dr Randall is under the influence of alcohol:

When patient care is at risk, this is almost always very important. Patients should always be
prioritised and their health and safety is paramount.

Dr Randall potentially getting angry and shouting at Anthony on the ward:

Dr Randall getting angry may upset patients on the ward, particularly as it is a geriatric ward and
patients are more likely to be confused and worried. This may indirectly impact on the care they
receive so this is important.

The impact on your grades at medical school:

Although confronting Dr Randall may lead to a damage in your professional relationship and
academic grades, you should not let this reason deter you from speaking to him. While grades are
important in your progression throughout medical school, you should prioritise patient safety.

Lee, a final year medical student, is having lunch alone in the hospital canteen. He overhears two
students, John and Sarah, talking about their upcoming exams. These exams are to be held online
and they are not proctored. He hears the students discussing ways of cheating in the exam but there
is no mention of them actively wanting to cheat.

How appropriate are each of the following responses by Lee in this situation?

Ask John and Sarah if they were planning to cheat in the exam:

This is a good way of dealing with the situation. Lee is not certain that they were going to cheat so it
will help clarify any misunderstandings. Additionally, this avoids confrontation and avoids assuming
that they will cheat which may make the issue easier to resolve.

Immediately report Sarah and John to the medical school head:

It is wrong to immediately report Sarah and John because Lee is not certain about whether they plan
to cheat or not. They could be honestly expressing their worries that other students may cheat in the
exams.
Ask Sarah and John to leave the public lunch area as patients may be within earshot and may lose
their trust in the medical profession:

This response is quite dramatic however there is a good underlying point. They could be discussing
something that they are not willing to actively carry out, but the public may misinterpret this. Asking
them to leave may make it very obvious to people nearby but it is not a terrible thing to do.

Explain to Sarah and John sensitively that people may be able to hear them:

This is appropriate as it will warn Sarah and John that people may hear them. However, it does not
tackle the route of the problem which is the cheating issue. It is important that they are aware of
this.

In an online problem-based learning session, Izzy finds that the facilitator, Jing, is behaving rudely
towards her. Jing had asked Izzy to answer a question to which she did not know the answer. Jing
laughed and said under his breath, "I don't know what they teach you students in medical school
these days". This is the first time that it has happened and she has felt upset as a result.

How appropriate are each of the following responses by Izzy in this situation?

Report Jing to the medical school head:

It is very inappropriate to report to the medical school head without first speaking to Jing to explore
why he said that and if there was any malice behind it. As a rule of thumb, it is usually best to resolve
things locally before getting more parties involved.

Talk to the other students and ask whether they felt Jing was being rude:

This is appropriate, but not ideal, as it does not go to the route of the problem. Talking to other
students would give Izzy another opinion and see if other students found Jing's behaviour to be
rude.

Talk to Jing privately about the situation and the feelings that resulted from it:

This is a very appropriate and honest response. Talking to Jing privately will allow matters to be
resolved locally and also explore what both parties were feeling. This may also prevent similar
situations from happening in the future.

Consult friends from different years in medical school and ask if they have had similar experiences
with Jing:

This is akin to gossiping. It is unfair to reference Jing's name to other students who weren't present
in the situation and may damage Jing's reputation, particularly if he had made an honest mistake. It
would be much more preferable to speak to Jing directly.

A group work assignment has been set and tasks have been equally split between four students:
Jack, John, Sarah and Izzy. Jack notices that Izzy isn't pulling her weight and the deadline is looming
with only 1 week to go. The group need to analyse the data in time to deliver an online presentation.
How important to take into account are the following considerations for Jack when deciding how to
respond to this situation?

The effect on the group's result if Izzy does not contribute to the assignment:

Medical students will need to meet certain criteria which involves passing exams and submitting
coursework in order to progress through medical school. As this is not a scenario that involves
patient care and it focusses on the group work assignment, this is very important to fix as it may
impact on the group's ability to progress.

That Izzy may be encountering a lot of stress and there may be a valid reason why she has not
contributed:

As a medical student and future doctor, it is important to look after those around you as well as your
patients. There may be something that is troubling Izzy and this is important to sort out. It would be
worth speaking to her privately to help her.

That Izzy does part-time work and this may be impacting on her ability to contribute:

This is important as it may genuinely impact on her ability to contribute, however, medical school
requirements are such that certain criteria need to be met in order to progress so Izzy will need to
contribute and may need external help to do so.

That other people have said that Izzy never contributes to coursework anyway so there is no point
talking to her about it:

It is best not to rely on gossip when making judgements about people. It is also useful to give the
benefit of the doubt, particularly with someone who you may not know well. There may be a
genuine reason why Izzy hasn't contributed thus far.

During hospital placement, Usman doesn't feel safe on the wards as the hospital often don't have
enough gloves and aprons to last the day.

How appropriate are each of the following responses by Usman in this situation?

Post on social media about the state of the hospital:

This is highly inappropriate. Medical students and healthcare professionals need to be very careful
about posting on social media. It could be that the hospital management is unaware of this situation.
It would be worthwhile to try and solve this locally.

Talk to the staff on the ward about the lack of supplies:

This is a very appropriate response. The staff may well be unaware of the situation and bringing it to
their attention may lead to a solution.

Talk to other medical students on the ward to see if they have experienced the same thing:

This is very appropriate. If other students are experiencing the same thing, this gives more grounding
for support to look for a solution.

Talk to the head of the hospital:

Dramatic responses such as this often are very inappropriate. It escalates the situation without
trying to solve it locally.

You will be presented with two sets of shapes and a test shape, then asked to decide if the test
shape belongs to Set A, Set B or Neither.

Neither is the answer here. There are two black hexagons which do not fit the pattern of either set.

In Set A, when the white shape is larger than the black shape, the arrow points left. When the black
shape is larger than the white shape, the arrow points right.

In Set B, when the white shape is larger than the black shape, the arrow points right. When the black
shape is larger than the white shape, the arrow points left.