Answering A White Space Question

At choir practice this week I was minding my own business (and in a very annual leave sort of headspace) when I was asked about white space questions and the Foundation Programme.

And do you know, I was so flustered by being asked that I couldn’t remember what any of my white space questions had been. It is three years ago this week since I applied for my first proper job as a doctor, and those three years feel like a lifetime and then some. Besides, I thought that my FY1 cohort had been the last to do white space questions and that after that they had gone the way of the Dodo and cassette tapes.

A little digging reveals that for the main intake of FY1s, white space questions have indeed gone and have been replaced by something called the Situational Judgement Test – a national multiple-choice exam of professionalism and common sense about which I can offer no advice whatsoever, having sat the pilot exam in 2012 and still been able to make neither heads nor tails of the thing. However, a little further digging reveals that the white space questions still very much form part of the assessment for those applying to the academic Foundation Programme.

A white space question, for the uninitiated, looks something like this (two real examples from 2011/12):

Two essential attributes of a foundation doctor are to deal effectively with challenge and to demonstrate initiative. Describe a clinical case in which you have been involved and use this example to demonstrate how you possess both of these qualities. How will you apply what you have learned from this experience to your work as a foundation doctor?

An understanding of appropriate professional behaviour is an essential requirement for a foundation doctor. You are a foundation doctor based on a busy medical ward. You are reviewing a patient for discharge when your bleep goes off. You excuse yourself to answer your bleep and return to find the patient reading your list of tasks that you have left on the bed. This includes patient names and diagnoses. What would your initial response be? What factors contribute to the pressure of the situation and how would you prioritise further actions? How may this scenario inform your professional behaviour as a foundation doctor?

As you can see, the questions come in two basic forms: the kind that poses a hypothetical scenario for you to answer some questions about, and the kind that asks you to use actual scenarios from your own experience to illustrate an answer to the question(s) that they have asked. Now, I haven’t seen the 2014/15 questions for the AFP and I wouldn’t offer any specific advice even if I had. But let me offer a few bits of general advice:

  • Answer the question.
  • Answer the whole question. You will see that in the two examples I’ve given, each one is actually asking three questions.
  • Focus. The word limit is (still, I think) 200 words per question. This is practically nothing.
  • A well structured answer is shorter to write, easier to read, and demonstrates organised thinking.
  • If you are asked to describe a clinical case that you have been involved in, there are no points for choosing an interesting case. The prudent thing to do is to choose a case that you can then use to effectively answer the rest of the questions. This might be a comparatively dull case, and that’s OK. (My worst score was on that first question, when I got fixated on an interesting thing that happened on my elective and then couldn’t really apply it to FY1.)
  • Officially, there are no buzzwords. Unofficially, you’ll not go far wrong with Good Medical Practice and particularly the GMC’s Duties of a Doctor.
  • If you are given a hypothetical case which is based on some kind of wrongdoing on your part, do at least three things: apologise, admit your wrongdoing, and tell your senior. And then apologise again. In some cases, you should also speak to your defence union.
  • If you are given a hypothetical case in which a patient could be said to have done something wrong, like reading your jobs list or even like refusing to take their medications, do not under any circumstances berate the patient. (I wish that wasn’t based on things I’ve seen actual people write.)
  • Get at least one proof-reader. By the end, you’ll have stared at the thing for so long that you could be reading the St Crispin’s Day speech for all the mistakes you’ll be able to identify.
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