Behavioural sciences and ethics for FCPS Part 1
Behavioural science questions are scenario questions. Name the principle, the defence mechanism or the learning type in the story, and most of them answer themselves.
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Why these marks are worth taking seriously
Many candidates leave behavioural sciences to the last week because it feels like common sense. Then the questions turn out to be precise. The options are all reasonable-sounding behaviours, and only one fits the textbook definition.
The good news is that the subject is small and the questions follow a pattern. Almost every stem is a short story with one thing to name:
- the ethical principle at stake
- the defence mechanism a patient is using
- the type of learning in a behaviour
- the right next step in communication
- whether a patient has capacity
Learn the definitions exactly, then practise naming them in stories.
Ethics: the four principles
| Principle | In one line | Typical stem |
|---|---|---|
| Autonomy | A capable adult decides for themselves | A patient refuses surgery after a full explanation |
| Beneficence | Act in the patient's best interest | Recommending effective treatment |
| Non-maleficence | Do no harm | Stopping a test that adds risk without benefit |
| Justice | Fair use of resources | Deciding who gets the last ICU bed |
Consent and capacity
Valid consent needs three things: capacity, enough information (including material risks and alternatives) and no coercion. It can be withdrawn at any time.
A patient has capacity if they can understand, retain, weigh and communicate the decision. Capacity is decision-specific and can change over time.
The classic trap: an unwise decision does not mean the patient lacks capacity. If a competent adult refuses a blood transfusion for religious reasons, you respect it, even if they may die.
In an emergency, when a patient lacks capacity and treatment cannot wait, you treat in their best interests and do only what is immediately necessary.
Confidentiality
Confidentiality can be broken in three situations:
- The patient consents.
- The law requires it (notifiable diseases, a court order).
- There is a serious risk to others (public interest), for example a driver with uncontrolled seizures who keeps driving after being told to stop.
When you do disclose, share the minimum necessary and, where safe, tell the patient first.
Breaking bad news: SPIKES
| Step | What you do |
|---|---|
| Setting | Private room, sit down, enough time, a relative if the patient wants |
| Perception | Ask what they already know |
| Invitation | Ask how much they want to know |
| Knowledge | Give a warning shot, then information in small pieces |
| Emotions | Allow silence, acknowledge feelings |
| Strategy and summary | Plan next steps and follow-up |
If a question asks for the first step, the answer is about the setting.
If relatives ask you not to tell the patient (collusion), explore why they are worried. The competent patient still has the right to know if they want to.
Defence mechanisms
These are the most reliable marks in the subject once the definitions are exact.
| Mechanism | Scenario that points to it |
|---|---|
| Denial | After a heart attack, the patient insists it was indigestion and wants to go home |
| Projection | A man who is unfaithful accuses his wife of having an affair |
| Displacement | Angry at the consultant, the registrar shouts at the house officer |
| Regression | A capable adult becomes childlike and dependent in hospital |
| Rationalisation | "I failed because the paper was unfair" |
| Intellectualisation | Discussing survival statistics in detail to avoid feeling afraid |
| Reaction formation | Being overly kind to someone you dislike |
| Sublimation | Channelling aggression into competitive sport (a mature defence) |
| Splitting | "You are the best doctor; everyone else here is useless" |
Watch the difference between repression (unconscious) and suppression (conscious and mature).
Learning theory
- Classical conditioning: a neutral cue becomes linked to a response. Anticipatory nausea before chemotherapy is the textbook example.
- Operant conditioning: consequences shape behaviour.
- Negative reinforcement increases a behaviour by removing something unpleasant. Taking a painkiller to stop pain is negative reinforcement, not punishment.
- A variable ratio schedule is the hardest to extinguish. That is why gambling is so persistent.
- Observational learning is learning by watching a model, such as children copying a parent who smokes.
Illness behaviour
The question here is usually who is producing symptoms on purpose, and why.
| Condition | Symptoms produced | Motive |
|---|---|---|
| Conversion/somatic symptom disorder | Unconsciously | Unconscious |
| Factitious disorder (Munchausen) | Consciously | To be a patient |
| Malingering | Consciously | External gain, such as compensation or leave |
The sick role gives two rights (exemption from normal duties, not being blamed) and two duties (wanting to get well, seeking and cooperating with help).
Grief and dying
Kübler-Ross described denial, anger, bargaining, depression and acceptance. People do not always pass through them in order.
Briefly hearing the voice of someone who has died can be part of normal grief. Grief becomes abnormal when it is very delayed, prolonged with severe impairment, or comes with suicidal thoughts or psychotic features.
Delirium versus dementia
| Feature | Delirium | Dementia |
|---|---|---|
| Onset | Hours to days | Months to years |
| Course | Fluctuating | Slowly progressive |
| Attention | Impaired early | Normal early |
| Consciousness | Clouded | Clear until late |
In an older surgical patient who becomes confused at night, think infection, drugs, retention, constipation, pain and electrolytes before you think dementia.
Common traps
- Asking a patient directly about suicidal thoughts does not increase the risk.
- A previous suicide attempt is the strongest predictor of suicide.
- Use a professional interpreter, not a family member, for important conversations.
- The active–passive doctor–patient model fits an unconscious patient. Mutual participation fits chronic disease such as diabetes.
How to revise in one week
- Day 1: ethics principles, consent, capacity and confidentiality.
- Day 2: communication, SPIKES and the doctor–patient models.
- Day 3: defence mechanisms. Write your own one-line story for each.
- Day 4: learning theory and memory.
- Day 5: illness behaviour, grief, culture and addiction.
- Days 6 to 7: delirium, depression, anxiety and sleep, then mixed scenarios.
Practise these scenarios in the FCPS-1 Prep question bank. Each explanation says why the other options do not fit the story, which is exactly the skill these questions test.
Read next: Common FCPS Part 1 mistakes · Breaking bad news in house job · Biostatistics for FCPS
Frequently asked questions
Is behavioural science really tested in FCPS Part 1?
Yes. It is a listed part of the Paper 1 syllabus, and the questions are scenario-based rather than pure recall.
Do I need a separate book?
A short review chapter is enough if you practise scenario questions. The definitions matter more than the volume of reading.
How do I tell malingering from factitious disorder?
Ask what the person gains. If it is something outside medicine, such as money or leave, it is malingering. If the aim is simply to be a patient, it is factitious disorder.