General Surgery Board Review Professional Standards & Competencies 5 — Questions and Answers
Question 1: A patient requests a copy of their operative report. Under HIPAA, the covered entity must provide this within:
- 7 calendar days
- 30 calendar days (extendable by 30 days once) (Correct answer)
- 60 days with no extension
- 90 days if records are archived
Correct answer: 30 calendar days (extendable by 30 days once)
HIPAA requires covered entities to provide access to records within 30 days, with one 30-day extension if notice is given.
Question 2: A surgeon consistently ranks in the lowest performance quartile on NSQIP risk-adjusted outcomes. The most appropriate institutional response is to:
- Immediately revoke surgical privileges
- Initiate a focused professional practice evaluation (FPPE) (Correct answer)
- Require the surgeon to repeat residency training
- Report the surgeon to the state board without further review
Correct answer: Initiate a focused professional practice evaluation (FPPE)
FPPE is the appropriate structured review process triggered by identified performance concerns before privilege action is taken.
Question 3: When a surgeon who holds a financial interest in a surgical center refers patients there, disclosure to patients is required by:
- The Stark Law only for Medicare/Medicaid referrals (Correct answer)
- No law if the center is accredited
- State licensure boards only
- The ACS Code only, not federal law
Correct answer: The Stark Law only for Medicare/Medicaid referrals
The Stark Law (Physician Self-Referral Law) prohibits undisclosed self-referrals for Medicare/Medicaid patients and requires disclosure of financial relationships.
Question 4: During a difficult laparoscopic cholecystectomy, the attending surgeon allows the chief resident to perform the critical view of safety dissection under direct supervision. This practice is:
- A violation of standard of care
- Appropriate graduated autonomy consistent with training objectives (Correct answer)
- Permitted only if the patient explicitly consented to resident involvement
- Against Joint Commission policy
Correct answer: Appropriate graduated autonomy consistent with training objectives
Graduated autonomy under direct supervision is a core principle of surgical education and is ethically and professionally appropriate.
Question 5: A surgeon in a rural solo practice is preparing to retire. Their primary ethical obligation to current patients is to:
- Post a notice in the local newspaper 30 days prior
- Ensure each active patient receives adequate notice and transfer of care arrangements (Correct answer)
- Transfer all records to the hospital medical records department
- Notify only patients with upcoming scheduled procedures
Correct answer: Ensure each active patient receives adequate notice and transfer of care arrangements
Retiring surgeons must provide adequate notice and help arrange transfer of care for all active patients to avoid abandonment.
Question 6: Which of the following scenarios represents a sentinel event requiring root cause analysis under Joint Commission standards?
- A patient develops a wound infection after colectomy
- A wrong-site amputation performed on an anesthetized patient (Correct answer)
- A resident misses a diagnosis later corrected at attending rounds
- A DVT occurring despite standard prophylaxis
Correct answer: A wrong-site amputation performed on an anesthetized patient
Wrong-site surgery is a classic sentinel event requiring mandatory root cause analysis under Joint Commission standards.
Question 7: A surgeon receives an unsolicited gift from a pharmaceutical company valued at $150. According to AMA guidelines, the appropriate action is to:
- Accept if the gift is educational in nature
- Accept only if disclosed to the hospital compliance office
- Decline the gift regardless of its nature or value (Correct answer)
- Accept gifts under $200 per AMA threshold
Correct answer: Decline the gift regardless of its nature or value
AMA guidelines advise physicians to decline gifts from industry that could create real or perceived conflicts of interest, regardless of value.
General Surgery Board Review Professional Standards & Competencies 5
A patient requests a copy of their operative report.
Under HIPAA, the covered entity must provide this within: