32 cardsUKMLA Applied Knowledge Test (MSRA-style single best answer)
UKMLA Ethics, Law and Research Methods
32 flashcards on UK medical law, GMC principles, statistics and study design for medical exams. Study material for exam revision, not legal or clinical advice.
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Mental Capacity Act: five statutory principles
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1
Mental Capacity Act: five statutory principles
1. Assume capacity unless shown otherwise. 2. Give all practicable help before deciding someone lacks capacity. 3. An unwise decision is not proof of incapacity. 4. Act in the person's best interests. 5. Choose the least restrictive option.
2
Mental Capacity Act: functional test
A person is unable to decide if they cannot understand the relevant information, retain it, use or weigh it, or communicate their decision. Capacity is decision-specific and time-specific.
3
Montgomery (2015)
The Supreme Court held that a doctor must take reasonable care that the patient is aware of material risks and of reasonable alternatives. A risk is material if a reasonable person in the patient's position would attach significance to it, or the doctor knows the patient would.
4
Gillick competence and Fraser guidelines
A child under 16 can consent to treatment if they have sufficient understanding and intelligence. The Fraser criteria apply specifically to contraceptive advice without parental knowledge.
5
Mental Health Act 1983: section 2
Detention for assessment for up to 28 days. It cannot be renewed. It needs two doctors and an approved mental health professional.
6
Mental Health Act 1983: section 3
Detention for treatment for up to 6 months, which can be renewed. It follows an assessment and also needs two doctors and an approved mental health professional.
7
Mental Health Act 1983: section 5(2)
The doctor in charge of an inpatient's care can hold the patient for up to 72 hours to allow a Mental Health Act assessment.
8
Mental Health Act 1983: section 136
A police power to remove a person who appears to have a mental disorder from a public place to a place of safety for assessment, for up to 24 hours.
9
Lasting power of attorney
Two types: property and financial affairs, and health and welfare. A health and welfare attorney can act only when the donor lacks capacity, and the LPA must be registered with the Office of the Public Guardian.
10
Independent mental capacity advocate
Must be instructed for serious medical treatment or a change of accommodation when a person lacks capacity and has no appropriate family or friends to consult.
11
Advance decision to refuse treatment
Legally binding if valid and applicable. To refuse life-sustaining treatment it must be in writing, signed and witnessed, and state that it applies even if life is at risk.
12
Duty of candour
Be open and honest with patients when something goes wrong: tell them promptly, apologise, explain what happened and what will be done, and report the incident through safety systems.
13
Confidentiality: disclosure without consent
Permitted when required by law, or in the public interest to prevent serious harm, such as serious crime or a patient who continues to drive when unfit. Tell the patient first where safe, disclose only what is needed, and record the reasons.
14
Reporting knife and gunshot wounds
GMC guidance: inform the police quickly when someone arrives with a gunshot wound or a knife wound from a violent attack. The patient's identity is not needed at the first call.
15
Female genital mutilation duty
Regulated health professionals in England and Wales must report to the police when they discover FGM in a girl under 18 (known by disclosure or physical signs).
16
Organ donation in England
Deemed consent (opt-out) system since 2020. Adults are treated as willing donors unless they opted out or are in an excluded group, and the family is still consulted.
17
Deprivation of liberty
Restrictions amounting to a deprivation of liberty for a person lacking capacity need legal authorisation, currently through the Deprivation of Liberty Safeguards (DoLS). The Liberty Protection Safeguards were legislated as the successor but their implementation has been delayed with no date set.
18
Sensitivity and specificity
Sensitivity = true positives / (true positives + false negatives). Specificity = true negatives / (true negatives + false positives). They do not depend on prevalence.
19
Predictive values
Positive predictive value = true positives / all positive tests. Negative predictive value = true negatives / all negative tests. Both change with prevalence.
20
Likelihood ratios
Positive LR = sensitivity / (1 - specificity). Negative LR = (1 - sensitivity) / specificity. Post-test odds = pre-test odds x likelihood ratio.
21
Absolute and relative risk reduction, NNT
ARR = control event rate - treatment event rate. RRR = ARR / control event rate. NNT = 1 / ARR.
22
Odds ratio in a 2 by 2 table
Odds ratio = (exposed cases x unexposed controls) / (unexposed cases x exposed controls). Used in case-control studies.
23
Type I and type II errors
Type I: rejecting a null hypothesis that is true (false positive), probability alpha. Type II: failing to reject a null hypothesis that is false (false negative), probability beta. Power = 1 - beta.
24
Interpreting a p-value
The probability of obtaining results at least as extreme as those observed if the null hypothesis were true. It is not the probability that the hypothesis is true and does not measure effect size.
25
Confidence interval and significance
A 95 percent confidence interval for a ratio (relative risk, odds ratio, hazard ratio) that includes 1, or for a difference that includes 0, indicates a result that is not statistically significant at the 5 percent level.
26
Standard deviation and standard error
Standard deviation describes the spread of individual values. Standard error of the mean = SD / square root of n and describes the precision of the sample mean.
27
Normal distribution
About 68 percent of values lie within 1 SD of the mean, 95 percent within about 2 SD (1.96) and 99.7 percent within 3 SD.
28
Skewed data
In positive skew, mean > median > mode, and the median is the better summary. In negative skew, the order is reversed.
29
Study designs
Randomised trial: tests an intervention. Cohort: follows exposed and unexposed groups forward and measures incidence and relative risk. Case-control: compares exposure in cases and controls and suits rare diseases. Cross-sectional: measures prevalence at one time.
30
Common biases
Selection bias; recall bias (case-control); lead-time bias (screening survival); publication bias (funnel plot asymmetry); confounding (a factor linked to both exposure and outcome); observer bias (reduced by blinding).
31
Intention-to-treat analysis
Participants are analysed in the groups to which they were randomised, whatever treatment they received, which preserves the benefit of randomisation.
32
Wilson and Jungner screening criteria
The condition is an important health problem with a recognisable early stage and known natural history. A suitable, acceptable test exists, an accepted treatment is available, and facilities, cost and a policy for who to treat are in place.
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