Ethics · Advanced · Medical Error

Complications Following Abdominal Surgery

Practise this PLAB 2 ethics station on Post-Operative Complications. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a GP surgery. Mr Wale Osei, a sixty-two-year-old man, has come in for follow-up after an abdominal hernia repair done at the hospital six weeks ago. Recent imaging has revealed a retained surgical instrument (swab or retractor) left inside his abdomen. You must inform him of this serious error, explain what has happened, discuss the need for further surgery, and address the duty of candour and his right to complain.

Background notes: PMH: Nil significant, fit and active

What this station tests

  • Wound infection rates: 5-10% for abdominal surgery, a recognised complication
  • Reviewing records objectively: was prophylaxis given, was the complication managed promptly
  • Duty of candour if a gap is identified: honest disclosure
  • Supporting the complaint process while providing ongoing care
  • Distinguishing recognised complications from errors

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

Post-operative complication follow-up requires honest assessment of whether the complications were expected or unexpected, and whether they were managed appropriately. Mr Osei is 62, attending for follow-up after abdominal surgery complicated by wound infection and prolonged recovery. Open with: 'Mr Osei, I want to review how your recovery has been and address any concerns you have.'

Core approach

Review the post-operative course. He had abdominal surgery, developed a wound infection requiring IV antibiotics and prolonged hospitalisation, and feels the complications were avoidable. He wants to know: was this normal? Could it have been prevented? Was something done wrong?

Honest assessment. Wound infection after abdominal surgery occurs in 5 to 10% of cases even with optimal technique and prophylactic antibiotics. It is a recognised complication, not necessarily an error. However: was antibiotic prophylaxis given? Was surgical technique appropriate? Was the wound infection recognised and treated promptly? Review the records objectively.

If management was appropriate: explain that complications occur despite best practice. If there was a gap: duty of candour applies.

Closing and safety netting

Assess his current recovery: is the wound healed? Any ongoing symptoms? Is he back to normal function? Address his questions honestly. If he wants to complain: PALS. If he has specific concerns about surgical technique or care: offer a meeting with the surgical consultant.

Reassure about ongoing care: 'Whatever happened during the surgery, my priority is making sure you recover fully.' Safety net: 'If you develop any new symptoms from the wound, come back.' Follow-up as needed.

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 (Supporting)

Scores well: Post-op course reviewed. Current recovery assessed. Records checked objectively.

Costs marks: Not reviewing records.

Domain 2 (Primary focus)

Scores well: Complication rate communicated. Records reviewed. Duty of candour if gap found. PALS offered. Surgeon meeting offered.

Costs marks: Defensive. Not reviewing. Not offering surgeon meeting.

Domain 3 (Primary focus)

Scores well: Honest assessment. Acknowledging his frustration. Not dismissive. Objective.

Costs marks: Dismissive. Defensive. Not acknowledging his experience.

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. Dismissing his concerns: 'complications happen' without reviewing the specifics
  2. Being defensive without reviewing the records: he deserves an objective assessment
  3. Not offering a meeting with the surgeon: the operating surgeon should be available to discuss

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

What is the right way to handle the post-Operative complications scenario in this station?

Post-operative complication follow-up requires honest assessment of whether the complications were expected or unexpected, and whether they were managed appropriately. Mr Osei is 62, attending for follow-up after abdominal surgery complicated by wound infection and prolonged recovery. Open with: 'Mr Osei, I want to review how your recovery has been and address any concerns you have.'

Where are marks won and lost in this post-Operative complications station?

Examiners reward: Post-op course reviewed. Current recovery assessed. Records checked objectively. Candidates are penalised for: Not reviewing records.

Where do candidates most often go wrong in this station?

Dismissing his concerns: 'complications happen' without reviewing the specifics. Another frequent error: Being defensive without reviewing the records: he deserves an objective assessment.

Can I do well in this station without real-world experience of post-Operative complications?

Structure beats experience here. Focus on reviewing records objectively: was prophylaxis given, was the complication managed promptly. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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