ECFMG Professionalism & Ethics 2 — Questions and Answers
Question 1: A patient with limited English proficiency refuses a professional interpreter and asks her adult son to translate during a sensitive gynecologic exam. What is the most appropriate next step?
- Proceed with the son as interpreter to respect patient autonomy
- Decline to see the patient until a professional interpreter is available
- Use a professional interpreter after explaining the risks of using a family member (Correct answer)
- Document that the patient refused care and discharge her
Correct answer: Use a professional interpreter after explaining the risks of using a family member
Physicians should explain confidentiality and accuracy risks of using family interpreters and offer professional services, while ultimately respecting a competent patient's informed choice.
Question 2: During a residency program, a supervising attending asks a resident to document a procedure as 'performed by attending' when the resident actually performed it independently. The resident should:
- Comply to maintain the attending-resident relationship
- Document accurately and report the discrepancy to the program director if pressured (Correct answer)
- Document as instructed since the attending supervised remotely
- Refuse to document the case at all
Correct answer: Document accurately and report the discrepancy to the program director if pressured
Falsifying medical records is fraud; the resident must document accurately and escalate if pressured to commit dishonest documentation.
Question 3: An IMG receives a gift of significant monetary value from a grateful patient's family after a successful surgery. According to ECFMG professional standards, what is the best response?
- Accept the gift graciously as it does not affect future care
- Accept only if the value is under $100
- Decline the gift and explain the professional reasons for doing so (Correct answer)
- Accept and report it to the hospital ethics committee
Correct answer: Decline the gift and explain the professional reasons for doing so
Accepting significant gifts can compromise objectivity and violate professional boundaries; declining with a kind explanation is the ethical standard.
Question 4: A physician discovers that a colleague has been practicing while impaired by alcohol during overnight shifts. The physician's primary obligation is to:
- Confront the colleague privately and wait for self-correction
- Report concerns to the appropriate authority to protect patient safety (Correct answer)
- Avoid involvement to preserve collegial relationships
- Document observations but take no action unless a patient is harmed
Correct answer: Report concerns to the appropriate authority to protect patient safety
Protecting patients from an impaired colleague supersedes collegial loyalty; reporting to appropriate authorities is the professional duty.
Question 5: A terminally ill patient who is a Jehovah's Witness and has decision-making capacity refuses a life-saving blood transfusion. The ethical principle that most directly supports honoring this refusal is:
- Beneficence
- Non-maleficence
- Justice
- Autonomy (Correct answer)
Correct answer: Autonomy
Autonomy grants competent adult patients the right to refuse any treatment, including life-saving interventions, based on personal or religious beliefs.
Question 6: An IMG applying for ECFMG certification discovers an error on a previously submitted application form. What should the applicant do?
- Ignore the error if it does not affect certification eligibility
- Correct the error proactively by contacting ECFMG immediately (Correct answer)
- Wait to see if ECFMG notices the discrepancy
- Submit a new application and abandon the prior one
Correct answer: Correct the error proactively by contacting ECFMG immediately
ECFMG requires honest and accurate documentation; proactively correcting errors demonstrates integrity and is required under its policies.
Question 7: A medical student on clinical rotation witnesses an attending make a demeaning comment about a patient's weight in front of the care team. The most professional response is to:
- Laugh along to fit into the team culture
- Privately speak with the attending afterward and express concern about the comment (Correct answer)
- Immediately confront the attending in front of the patient
- Report the attending to hospital administration without speaking to them first
Correct answer: Privately speak with the attending afterward and express concern about the comment
Addressing unprofessional behavior privately first is appropriate, constructive, and preserves the therapeutic environment for the patient.
ECFMG Professionalism & Ethics 2
A patient with limited English proficiency refuses a professional interpreter and asks her adult son to translate during a sensitive gynecologic exam.
What is the most appropriate next step?