General Surgery Board Review Professional Standards & Competencies 4 — Questions and Answers
Question 1: A surgeon performs a technically successful operation but fails to see the patient postoperatively for 5 days. This most likely constitutes:
- Acceptable practice if covered by residents
- Abandonment if no adequate coverage was arranged (Correct answer)
- Standard of care variation only
- A billing issue but not an ethical violation
Correct answer: Abandonment if no adequate coverage was arranged
Failing to provide or arrange adequate postoperative follow-up constitutes patient abandonment, an ethical and legal violation.
Question 2: Which of the following best illustrates the ACGME competency 'Interpersonal and Communication Skills'?
- Correctly diagnosing a rare abdominal condition
- Effectively disclosing a surgical complication to a distressed patient (Correct answer)
- Knowing the anatomy of the portal triad
- Managing a hospital-acquired infection appropriately
Correct answer: Effectively disclosing a surgical complication to a distressed patient
Disclosing complications with empathy and clarity directly reflects interpersonal and communication skills as defined by ACGME.
Question 3: Regarding the Universal Protocol (Time-Out), which element is MANDATORY before every surgical procedure?
- Review of the patient's insurance information
- Verbal confirmation of patient identity, site, and procedure by all team members (Correct answer)
- Presence of the hospital administrator
- Completion of a pre-anesthesia pharmacology checklist
Correct answer: Verbal confirmation of patient identity, site, and procedure by all team members
The Universal Protocol requires an active verbal time-out confirming patient identity, operative site, and procedure with all team members present before incision.
Question 4: A surgeon with known alcohol dependence in sustained remission applies for hospital privileges. The medical staff office should:
- Automatically deny privileges due to prior impairment history
- Grant unrestricted privileges without conditions
- Evaluate current fitness for duty and consider monitoring agreements (Correct answer)
- Defer the decision to the state medical board exclusively
Correct answer: Evaluate current fitness for duty and consider monitoring agreements
Credentialing bodies must assess current fitness for duty individually; a history of treated impairment does not mandate automatic denial under ADA principles.
Question 5: The ethical principle of 'justice' in surgical practice most directly applies when a surgeon:
- Discloses all risks of a procedure to the patient
- Allocates scarce ICU beds equitably among critically ill patients (Correct answer)
- Avoids actions that could harm the patient
- Acts in the patient's best interest against their stated wishes
Correct answer: Allocates scarce ICU beds equitably among critically ill patients
Justice refers to fair and equitable distribution of healthcare resources and treatment across patients.
Question 6: A surgeon's case is reviewed under peer review. Under most state laws, peer review proceedings are:
- Fully discoverable in malpractice litigation
- Protected from discovery to encourage candid quality improvement (Correct answer)
- Admissible as evidence of negligence
- Subject to FOIA requests by patients
Correct answer: Protected from discovery to encourage candid quality improvement
Most states grant peer review confidentiality protection so that providers can discuss cases honestly without fear of litigation discovery.
Question 7: Which statement about informed consent for surgical residents performing procedures is most accurate?
- Residents may obtain consent independently once they complete PGY-2
- The attending surgeon is ultimately responsible for ensuring informed consent is complete (Correct answer)
- Consent obtained by a resident is invalid and must be re-obtained by the attending
- Hospital policy determines whether residents can obtain consent, superseding ethical standards
Correct answer: The attending surgeon is ultimately responsible for ensuring informed consent is complete
While residents may participate in the consent process, the attending surgeon retains ultimate responsibility for ensuring the patient is truly informed.
General Surgery Board Review Professional Standards & Competencies 4
A surgeon performs a technically successful operation but fails to see the patient postoperatively for 5 days.
This most likely constitutes: