Anesthesiology APPLIED Exam › OSCE: communication and professionalism

Ethical principles reference (ASA guidelines)

OSCE: communication and professionalism·~5 min read· Physician-reviewed✓ Sourced · 3

Stem

Station prompt: Ms. Dana Whitfield, 46, is scheduled for an elective laparoscopic hysterectomy at a teaching hospital. A resident completed her preoperative interview; you are the attending anesthesiologist who will supervise the case. She has asked to speak with you before signing the anesthesia consent. Address her concerns. You have 8 minutes.

Question

The resident told me she'll be doing my anesthesia. I want to know who is actually putting me to sleep. Are you even going to be in the room?

Ideal answer

Headline"I'm Dr. Patel, the attending anesthesiologist, responsible for your anesthesia from start to finish. I'll be there when you go to sleep and wake up, and always immediately available."

Honesty about roles. "Thank you for asking me directly, Ms. Whitfield. You deserve a straight answer. Dr. Kim, the resident you met, is a doctor training in anesthesiology, and she will be part of your care. During the operation I may step out to check on one other patient; Dr. Kim calls me for anything unexpected."
Gather information. "Before I go on, can you tell me what's worrying you? Has something happened before, or did someone tell you something?" [She says a friend had a bad experience with a student.]
Promise only what is true. "That makes sense. I can promise I'll personally be there for induction and emergence, the two most important moments, I'll make the anesthetic plan with you right now, and you can ask for me at any time. I can't promise to be in the room every minute, and I won't pretend otherwise."
Her choice, and closure. "What would make you comfortable going ahead? What questions do you have? If you'd rather not decide today, that's your choice too, and I'll make sure the team knows what we agreed."

Breaking down the answer

Honesty about who does what — ASA principles: tell patients when trainees or other providers will likely take part, and be honest about your own involvement, which they call essential to informed consent.¹ This is ethical fidelity, promise keeping and trustworthiness, in the ABA's terms.²
Why ask before answering the fear — the outline scores obtaining relevant information and clarifying options before a decision.² Her worry has a story.
Autonomy, stated as choices — patients have a right to self-determination, and I personally take part in her decisions about the anesthetic.¹ Proceed, ask questions, or delay are real options.
Accountability — ASA principles expect the supervising anesthesiologist to be personally and continuously available and to take part in the most demanding parts of the anesthetic.¹
Negotiate, decide, document — the six outline principles are respect for autonomy, beneficence, non-maleficence, accountability, ethical fidelity and social and distributive justice, applied through gathering information, clarifying options, determining preferences, negotiating differences and deciding together.²
Use the reference map — the ASA document is organized by responsibilities to patients, colleagues, health care facilities, oneself, and community and society.¹ Most OSCE ethics stations sit in the first two.

Follow-up question

Ms. Whitfield folds her arms: "Then I don't want the resident touching me at all. If you can't promise that, I'm cancelling." How do you respond?

Follow-up answer

HeadlineAn informed request from a patient with capacity, not hostility. "You have every right to decide who takes part in your care."

I respect it: "I won't pressure you." I ask what she objects to: the airway, the IV, or any involvement at all. If I can personally deliver her anesthetic today, I arrange it with the resident; if not, I say so honestly and offer another date with an attending-only arrangement, or the parts the resident would not do. I never agree, then let the resident do it once she is asleep; anesthetized patients are especially vulnerable, and that breach would betray her trust and consent.¹ I document the agreement and tell the team and surgeon.

Pitfalls that cost points

Saying "I'll be there the whole time" when you won't.
Defending the training program instead of exploring her concern.
Treating her request as unreasonable or threatening to cancel for her.

Rapid-fire

Q: How do you approach a colleague you think is impaired? A: Privately advise them to stop practicing and support their treatment; report hazardous practice to the appropriate authority.¹

Q: How do you involve a 13-year-old in decisions? A: "I'd like to hear what you think too." Minors take part in decisions to the extent their development allows.¹

Q: A capacitated patient refuses the IV before induction. Do you restrain her? A: No; ASA principles say not to use our skills to restrain or coerce a patient with capacity.¹

Q: A relative asks for her results in the hallway. What do you say? A: "I need her permission before I can share anything." Confidentiality applies to medical and personal information.¹

Q: Which outline topics should you rehearse? A: Surrogates, capacity, informed refusal, confidentiality, obligations to colleagues, end-of-life care, organ procurement and conflicts of interest.²

Numbers to know

Item	Value
Station	8 min, 4-min read, warning at 6 min³
ABA ethical principles	6²
Process steps	Gather, clarify options, preferences, negotiate, decide²
ASA responsibility sections	5; 11 principles toward patients¹
ASA principles last amended	October 2025¹

Sources

1.Principles for the Ethical Practice of Anesthesiology (formerly Guidelines for the Ethical Practice of Anesthesiology) · ASA Committee on Ethics, 2025 · asahq.orgLast amended October 15, 2025; five sections of responsibilities: patients, colleagues, facilities, self, community and society.
2.APPLIED Examination OSCE Content Outline · ABA · theaba.org
3.What to Expect for Your APPLIED Exam (APPLIED Exam Manual) · ABA, 2026 · theaba.org

Facts on this page were checked against these sources on Oct 15, 2026. Guidelines change; confirm doses against current institutional protocols.