A junior trainee in distress has asked to speak to you regarding a medical error she has committed that has resulted in a life-threatening adverse outcome for the patient.
Outline the key points of the initial discussion with the trainee.
Answer and interpretation
The key points that the candidate needs to cover are:1. Facilitating the initial critical incident debrief of the Registrar and allowing him/her to vent and tell his/her version of events2. Ensuring there is ongoing psychological and emotional support for the Registrar
- Give him/her the option of standing down for the rest of the shift or providing
- support if he/she chooses to stay
- Arranging a mentor within the department (eg SOT)
- Ensuring there is back-up from friends/family at home
- Offering professional counselling
3. Providing advice on the medico-legal process that will ensue
- Open disclosure with family
- Need for comprehensive and accurate documentation in records and factual account for registrar’s own records
- Early contact with medical defence organisation and hospital medico-legal advisors
- Reporting to coroner if/when the patient dies
- The event will be the subject of a Root Cause Analysis by the hospital
4. Counselling with regards to future career and training
5. Arrange follow-up meeting with mentor and departmental head for next day
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.