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management for the FRCEM


Interview: Andy Neill

Interviewee: Vicky Meighan

The FRCEM in its current form contains a management viva. This will be changing over the next few years and ultimately will be replaced. This podcast contains specific advice for the current (this was recorded Nov 2015) management viva but the principles in it will likely be applicable to whatever replaces it as an exam. More importantly, the principles here will be useful to you as you embark on your consultant career.

This is NOT official college advice and the opinions here are very much our own. Don’t get upset if you follow our advice and end up in diffs.

Some tips

  • Arrive on time
  • dress well
  • practice, practice, practice… (consider recording your practice sessions)

The drill

  • Part 1 – In-tray exercise (5 mins reading | 15 min viva)
    • The candidate will be given a number of documents simulating a Consultant‟s “in-tray” of
    • management scenarios. The candidate has 5 minutes to read the material prior to the viva
  • Part 2 – Long Case (15 min viva)
    • The candidate is handed a single document describing a clinically related topic for discussion.
    • questions begin when you look up from your reading so read through it well and have a plan before you start to talk
    • Duration – each part of this examination is 15 minutes with a total viva time of 30 minutes (with 5 minutes reading time).
  • Speed read and link everything together
    • consider putting the longest bit of paper first to ensure you get through it
    • consider using the post it notes provided to highlight the themes for each piece of paper (eg “dr in difficulty” and a “patient safety” issue)
    • You need to read everything
  • Consider an opening scripted phrase

The approach to a management problem (credit to Dr Niamh Collins)

  1. Information gather
    1. notes
    2. people
  2. Patient safety
  3. Safety of:
    1. staff
    2. department
    3. public
  4. Refer to any policies, procedures, guidelines
  5. Action plan
    1. short term
    2. long term
  6. Teaching opportunities


  • principles
    • attempt to maintain it when possible
    • applies even after death
    • implies consent to disclose between health professionals
  • when you can break confidentiality (not an exclusive list)
    • if “in the best interest of patient or public” – this is of course open to interpretation
    • statutory requirements

Data Protection

  • Buzzwords
    • information governance
    • Caldicott principles
  • Data protection policy (NHS)
    • personal data will be processed fairly and lawfully
    • will be obtained for lawful purposes
    • must be adequate relevant and not excessive
    • must be kept up to date
    • must not be kept longer than necessary
    • must be processed in accordance with rights of data sunjects
    • must be kept secure
    • must not be transferred outside the European Economic area unless there is adequate protection
  • Caldicott principles
    • justify the purpose of using confidential information
    • only use when absolutely necessary
    • use the minimum required
    • access on a need to know basis
    • everyone must understand their responsibilities
    • understand and comply with the law

Serious incidents

  • Definition
    • unexpected or avoidable death or severe harm
    • a never event
    • a scenario that prevents an organisations ability to continue to deliver healthcare services inc data loss or incidents in population screening
    • allegations or incidents of physical abuse and sexual assault or abuse
    • loss of confidence in the service,adverse media coverage or public concern
  • Our response (based on serious incident framework. Note this is updated frequently so check it’s up to date)
    • patient and relatives must be cared for,their health and welfare secured and further risk mitigated..patient safety!staff/department! Make a contemporary note/mitigate risk of recurrence
    • report to local reporting systems/NRLS
    • inform patient
    • grade incident (no longer necessary)
    • report to commissioner within 2 working days. Record on STEIS strategic executive information system within 2 working days
    • Investigate
    • Action plan
    • Learn
    • Share learning

The coroner

  • report if:
    • Death due to an accident
    • Death due to self neglect or neglect by others
    • Death by suicide
    • Died a violent or unnatural death (including accident or suicide)
    • Died and the cause of death is unknown
    • Died while in custody or otherwise in state detention
    • Died as a result of a medical mishap, etc (this list is not exhaustive).
  • Inform:
    • GP
    • Family
    • Coroner

 Advance directives

  • Must have capacity and be over 18
  • Specifies the treatment to be refused
  • In regards to life sustaining treatment must be
    • written /signed/witnessed/contain a statement that applies even when ‘life is at risk’
    • if doubt in an emergency, can provide life saving treatment until the existence and legitimacy  of the ad have been confirmed

Lasting power of attorney

  • legal document, allows you to appoint someone that you trust as an attorney to make decisions on behalf of the patient,
  • needs to be registered with the office of the public guardian and can only be used when patient is unable to make their own decisions


  • Does the person have an impairment, or disturbance in the functioning, of their mind or brain? for example, conditions associated with mental illness, concussion, or symptoms of drug or alcohol abuse.
  • Does the impairment or disturbance mean that the person is unable to make a specific decision when they need to? You should offer all appropriate and practical support to achieve this before applying this stage of the test.
  • “Rugby Ruucs”
    • Retain the information
    • Understand the information
    • Use the information to make an informed decision
    • Communicate the information

Doctor in difficulty

  • remember patient safety may be an issue here
  • identify the problem area (NACT website useful)
    • Clinical performance
      • capability and learning
    • Health
      • physical and mental
    • Personality and behavior
    • Environment
      • home and work
  • referral pathway (lots of options)
    • HR
    • Educational Supervisor
    • Head of Deanery
    • Medical Director
    • OccH
    • GP

Complaints (NHS website)

  • well described pathway for this, check the site for up to date details prior to the exam


  • involve your media department in the hospital
  • maintain confidentiality
  • remember potential for positive spin for hospital and department.

Department withdrawing service

  • is there a patient safety issue
  • if so likely needs escalated to more senior members of management inc. risk management

Other Resources


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