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36 cardsPLAB 1 (GMC, international medical graduates)

GMC, UK Law and Evidence Essentials for PLAB 1

Thirty-six flashcards on consent, capacity, confidentiality, safeguarding, the Mental Health Act and the statistics formulae examined in PLAB 1.

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Good medical practice (2024): the four domains
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1
Good medical practice (2024): the four domains
Knowledge, skills and development; patients, partnership and communication; colleagues, culture and safety; trust and professionalism.
2
Montgomery v Lanarkshire (2015): disclosure of risk
Disclose material risks: those a reasonable person in the patient's position would consider significant, or that the doctor knows the patient would care about. Replaces the Bolam approach to risk disclosure.
3
Mental Capacity Act 2005: five principles
Presume capacity; support decision-making; an unwise decision is not incapacity; act in best interests; choose the least restrictive option.
4
Capacity: the two-stage test
1) Is there an impairment or disturbance in the functioning of the mind or brain? 2) If so, is the person unable to understand, retain, use or weigh, or communicate a decision? Capacity is decision-specific.
5
Gillick competence and Fraser guidelines
Gillick: an under-16 who fully understands the treatment may consent. Fraser criteria apply to contraception advice without parental knowledge.
6
Valid advance decision to refuse life-sustaining treatment
Must be written, signed and witnessed, and state it applies even if life is at risk. A valid, applicable ADRT has the force of a capacitous refusal.
7
Lasting power of attorney for health and welfare
Attorney acts only when the donor lacks capacity, in best interests. Life-sustaining treatment decisions need express authority in the document.
8
When is an IMCA instructed?
For serious medical treatment or change of accommodation when a person lacks capacity and has no appropriate family or friends to consult.
9
Three justifications for disclosing confidential information
Consent, a legal requirement (e.g. court order), or the public interest where benefit outweighs harm. Tell the patient first if safe and practicable.
10
GMC: gunshot and knife wounds
Inform the police quickly (GMC: usually) when a patient arrives with a gunshot wound or a knife or sharp-instrument wound from an assault. Do not give the patient's identity at first. Not usually for accidental or self-inflicted knife injuries.
11
FGM mandatory reporting duty (England and Wales)
Regulated professionals must report to the police known FGM in a girl under 18, either disclosed or seen on examination. At-risk cases go through safeguarding.
12
Under 13 and sexual activity
A child under 13 cannot legally consent to sexual activity (Sexual Offences Act 2003). Start child safeguarding procedures.
13
Adult safeguarding: legal basis in England
Care Act 2014 section 42: the local authority enquires when an adult with care needs is experiencing or at risk of abuse or neglect and cannot protect themselves.
14
Professional duty of candour
Be open and honest with patients when something goes wrong: tell them, apologise, explain, offer remedy, and report the incident.
15
Raising concerns in the NHS
Raise internally first, including via the Freedom to Speak Up Guardian. If unresolved, go to an external body such as the regulator. Disclosures are protected by law.
16
Medical examiner system (England and Wales)
Statutory since 9 September 2024: independent scrutiny of deaths not investigated by a coroner, and review of the cause of death before registration.
17
Organ donation law in England
Opt-out (deemed consent) since May 2020, with exceptions. The family is still approached.
18
Assisted suicide in England and Wales
A criminal offence under the Suicide Act 1961. Decline, explore concerns and offer palliative care.
19
Mental Health Act 1983: section 2
Assessment up to 28 days, not renewable. Needs an AMHP application and two medical recommendations, one by a section 12 approved doctor.
20
Mental Health Act 1983: section 3
Treatment up to 6 months, renewable. Needs an AMHP application and two medical recommendations. Entitles to free section 117 aftercare.
21
Mental Health Act 1983: holding powers
Section 5(2): doctor, up to 72 hours, for a hospital inpatient. Section 5(4): nurse, up to 6 hours. Section 4: emergency assessment, up to 72 hours.
22
Mental Health Act 1983: section 136
Police power to take a person from a public place to a place of safety for assessment; maximum 24 hours (extendable by 12). The Mental Health Act 2025 will remove police cells as places of safety for adults, but that is not yet in force.
23
Sensitivity and specificity
Sensitivity = TP / (TP + FN). Specificity = TN / (TN + FP).
24
Positive and negative predictive value
PPV = TP / (TP + FP). NPV = TN / (TN + FN). Both depend on prevalence.
25
Likelihood ratio positive and post-test odds
LR+ = sensitivity / (1 minus specificity). Post-test odds = pre-test odds multiplied by LR.
26
Number needed to treat
NNT = 1 / absolute risk reduction. Round up to the next whole number.
27
Relative risk and odds ratio
RR = risk in exposed / risk in unexposed. OR = (a x d) / (b x c) from the 2x2 table. Case-control studies give odds ratios.
28
95 percent confidence interval of a mean
Mean plus or minus 1.96 x standard error, where SE = SD / square root of n. If the CI for a ratio includes 1, the result is not significant at 5 percent.
29
What a p-value means
The probability of data at least this extreme if the null hypothesis were true. It is not the probability that the null is true.
30
Type I error, type II error and power
Type I: false positive (alpha). Type II: false negative (beta). Power = 1 minus beta.
31
Intention-to-treat analysis
Analyse participants in the groups they were randomised to, whatever treatment they received. Preserves randomisation and reduces bias.
32
Allocation concealment versus blinding
Concealment protects against selection bias at recruitment. Blinding reduces performance and detection bias afterwards.
33
Lead-time bias in screening
Earlier diagnosis makes survival from diagnosis look longer without delaying death. Compare mortality, not survival time.
34
Prevalence, incidence and duration
For a stable disease, prevalence is approximately incidence x mean duration.
35
Choosing a statistical test
Two independent means, normal: t-test. Paired means, normal: paired t-test. Non-normal independent: Mann-Whitney. Proportions: chi-squared. Three or more means: ANOVA.
36
NHS cancer and vascular screening in England
Cervical: 25 to 49 every 5 years if HPV negative (changed from 3 years on 1 July 2025; more frequent if HPV positive), 50 to 64 every 5 years. Breast: 50 up to 71st birthday every 3 years. AAA: men aged 65, one-off scan. NHS Health Check: 40 to 74, every 5 years.

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