Ethics · Advanced · Ethics

Burn Injury

Practise this PLAB 2 ethics station on Burn Injury (Suspected Trafficking). 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an A&E doctor seeing Miss Jane Gran, a 28-year-old woman, who has been brought in by a male companion with a significant burn injury to her upper left arm. The injury is patterned and the story about how it happened is vague and changes slightly. She seems anxious, submissive to her male companion, and reluctant to speak. She is wearing minimal clothing despite the cold weather, has multiple old bruises in various stages of healing, and appears malnourished. You are concerned that this may be trafficking and abuse. Please demonstrate appropriate safeguarding awareness, sensitive history taking, and discussion of support options.

Background notes: PMH: Nil significant

What this station tests

  • Separating the patient from the controlling companion: essential for assessment
  • Signs of trafficking: confiscated documents, debt bondage, multiple injuries, malnourishment, inability to leave
  • Modern Slavery Act 2015: trafficking victims are protected, not prosecuted
  • National Referral Mechanism: formal identification pathway for trafficking victims
  • Not letting the patient leave with the suspected trafficker

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself. Establish the ethical issue and your role.
  • 1-3 min — Explore Perspective: Listen to patient/relative perspective. Understand their reasoning and concerns.
  • 3-5 min — Ethical Framework: Apply ethical principles: autonomy, beneficence, non-maleficence, justice. Reference relevant guidelines (GMC, Mental Capacity Act).
  • 5-7 min — Negotiate and Plan: Find common ground. Explain your professional obligations. Involve MDT where appropriate. Document plan.
  • 7-8 min — Closing: Summarise agreed position. Outline next steps. Offer further discussion.

Consultation approach

The opening

A patient with a significant injury accompanied by a controlling companion raises trafficking concern. Miss Gran is 28, Chinese national, brought to A&E by a male companion with a burn injury. She seems frightened and the companion answers for her. Open with: speak directly to her, not the companion: 'Miss Gran, I need to examine your injury. I would like to speak to you alone. Could your companion wait outside?'

Core approach

Separate her from the companion. This is essential. You cannot assess trafficking with the controller present. Use clinical reasons: 'We need to examine you privately.' If the companion resists: insist (clinical need for privacy is non-negotiable in A&E).

Once alone: assess the injury (burn) and look for signs of trafficking. Multiple injuries at different stages of healing? Malnourished? Signs of physical or sexual abuse? Does she have her own passport and documents? (Traffickers confiscate documents.) Does she know her own address? Is she allowed to leave the house? Does she receive payment for work? Is she in debt bondage?

She may be frightened to disclose. She may have been told that police will deport her. Reassure: 'You are safe here. We are here to help you, not to get you in trouble.' Trafficking victims are protected under the Modern Slavery Act 2015.

Closing and safety netting

If trafficking is suspected: do not let her leave with the companion. Contact the Salvation Army Modern Slavery Helpline (08000 121 700) or the police Modern Slavery Unit. Hospital safeguarding team. She may be referred to the National Referral Mechanism (NRM) for formal identification as a trafficking victim.

Treat the burn injury. Assess for other medical needs (sexual health screening, nutrition, mental health). Document everything carefully. The companion should not be informed of your concerns. Safety is paramount: she must not be returned to the trafficking situation.

How examiners mark this station

Examiners will assess your ethical reasoning and interpersonal skills. Domain 2 (Clinical Management) is primary: marks for applying an ethical framework, referencing relevant legislation and guidelines, and reaching a reasoned position. Domain 3 (Interpersonal Skills) is equally weighted: marks for non-judgmental exploration, empathic communication, and negotiation skills. Domain 1 (Data Gathering) assesses your ability to fully explore the situation before forming a view.

Domain 1 (Primary focus)

Scores well: Patient separated from companion. Trafficking indicators assessed. Injury documented. Other injuries checked. Document and passport status checked.

Costs marks: Not separating. Not checking trafficking indicators. Not documenting.

Domain 2 (Primary focus)

Scores well: Modern Slavery Helpline contacted. Safeguarding team involved. NRM referral. Not discharging with companion. Burn treated. Other medical needs assessed.

Costs marks: Discharging with companion. Not contacting safeguarding. Not treating.

Domain 3 (Primary focus)

Scores well: Speaking directly to her, not companion. Reassuring about safety. Not making her feel like a criminal. Culturally sensitive.

Costs marks: Speaking to companion. Making her feel she is in trouble. Not reassuring about safety.

Common examiner feedback (and how to fix it)

Did not demonstrate adequate ethical reasoning or application of relevant guidelines

Fix: Structure your response around the four ethical pillars (autonomy, beneficence, non-maleficence, justice). Reference specific guidelines (GMC, Mental Capacity Act) where relevant.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: Acknowledge the emotional weight of the situation early. Show that you understand why this is difficult before applying ethical reasoning.

Common mistakes in this station

  1. Not separating her from the companion: assessment is impossible with the controller present
  2. Treating the burn and sending her back: this returns her to the trafficking situation
  3. Not recognising the trafficking indicators: a frightened foreign national with a controlling companion and significant injury

Resitting PLAB 2?

If you have found ethics stations difficult, focus on learning a clear ethical framework (the four pillars) and practising how to apply it conversationally rather than reciting principles. Examiners reward candidates who can explore the tension between competing ethical principles while remaining empathic and non-judgmental.

Example opening

Thank you for coming in to speak with me. My name is Dr [Name]. I understand there is something important we need to discuss. Could you tell me your understanding of the situation?

Frequently asked questions

How do I structure my approach to this burn injury (Suspected trafficking) consultation?

A patient with a significant injury accompanied by a controlling companion raises trafficking concern. Miss Gran is 28, Chinese national, brought to A&E by a male companion with a burn injury. She seems frightened and the companion answers for her.

What does a strong performance look like to the examiner in this station?

Strong performances show: Patient separated from companion. Trafficking indicators assessed. Injury documented. Other injuries checked. Document and passport status checked. Weak performances: Not separating. Not checking trafficking indicators. Not documenting.

What is the biggest pitfall in this burn injury (Suspected trafficking) station?

Not separating her from the companion: assessment is impossible with the controller present. Another frequent error: Treating the burn and sending her back: this returns her to the trafficking situation.

How should I prepare for burn injury (Suspected trafficking) if I have never seen it in practice?

Structure beats experience here. Focus on signs of trafficking: confiscated documents, debt bondage, multiple injuries, malnourishment, inability to leave. The written guidance on this page covers the full approach, and practising the consultation aloud builds the fluency the examiner is listening for.

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