OSCE 3: Mentor Meeting.
You are the ED consultant and mentor to a mid-level advanced trainee who has had a challenging case on their last clinical shift two days ago. You are on an administration day and have arranged this meeting.The trainee was the night registrar looking after a trauma patient who was hypotensive and the trainee performed an eFAST and found ‘fluid in the abdomen’. A code crimson was activated and the patient went to theatre without a CT. There was no intraperitoneal fluid found and subsequent CT was negative for abdominal injury. No ultrasound images were saved.The trainee is concerned about what will happen after this.
You are already aware of the case and know that an in-hospital investigation is already underway.
You have seven minutes
- Medical Expertise
- Professionalism and Decision Making
One Framework for a mentor meeting:
- Reassure the trainee that this meeting is confidential. You may have been asked by the DEMT to have the meeting as there are training issues but you are under no obligation to pass on what is said unless the trainee agrees. Even if you find they have a drug problem, yes this is reportable, but outside the hospital. You can tell the DEMT and Head of Department that they are off sick. Yes you have a duty of care to patients and patient safety, hence why some events are reportable but the mentor relationship should be one of trust and confidentiality to help support the trainee.
- If there was a critical incident, some people like to reassure the trainee with their own near miss but ultimately you need to state there are likely to be a number of factors at play and you wish to explore each of these before you make a plan.
- Evaluate the situation with ‘good judgement’. That doesn’t mean agreeing or saying ‘everything will be fine’ or ‘you did a good job’ when they didn’t. State what you feel is reasonable in the circumstances, good or bad but only after you have had their perspective of the situation. [Resource on debriefing with good judgement]
- If there has been behaviour that is unacceptable then you need to state this, and tell them what you expect from them and that any further repeats of this behaviour will have to be put down in their training record. Normally you would have a stem saying the DEMT has asked for a meeting as there has been a complaint. This makes the ‘reporting issue’ easier as you are there to get the trainee’s perspective and then debrief with ‘good judgement’. Hopefully by stating that ‘I understand work can be stressful but telling the pharmacist to f$#k off is unacceptable and you will need to apologise but I want to explore why you felt like this, what stresses do you have in your life?’ will get the response you are looking for.
- Identify learning needs, stresses, training problems, social problems, drugs, ETOH, health and depression where appropriate. Address each of these as required.
- Make sure the trainee feels safe going back out on the floor.
- Plan a follow up, if in reality you feel you do not have a good mentor relationship you could always refer them to another member of the team, mentor relationships are supposed to be at the trainee’s choice. It’s no good having a mentor you can not talk to.
Potential Marks in this case:
- Medical Expertise:
- Demonstrates knowledge of trauma guidelines and systematic approach.
- Understands why false positive scans may occur.
- Understands the need for a credentialing system in ED, saving of images and the pros and cons of bedside eFAST scans.
- Non-judgemental, supportive, empathetic and clear.
- Inquires into the trainees perspective of the situation.
- Acknowledges need for review and feedback from all staff involved.
- QA measures to improve on in the future.
- Explains the investigation process to the trainee in a clear manner.
- Ensures that the trainee has a follow up plan to discuss the case further and assesses trainee’s risk of adverse mental health effects from the incident.
- Professionalism and Decision Making
- Looks at the clinical situation and awareness of indications for referral to OT vs angio vs CT. Awareness of team approach and consultation with relevant senior in-patient team members.
Additional comments on this video:
- Liked the start, highlighting that this is a safe space.
- If the trainee is particularly nervous or anxious you may wish to give an example of something you missed early on to show it is something that will happen throughout all of our careers.
- Good exploration of the multiple factors involved.
Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.