Then later in the week they published the scores breakdown for our questions (each section scores out of ten points:
During a ward round on an ICU placement, a consultant was teaching me about ventilator function and the various modes available for use in a patient with pneumonia. The consultant organised a tutorial where, having established my background knowledge of respiratory anatomy and physiology, he used diagrams and patient scenarios and asked me to explain the pathophysiology of each patient, and choose a method of ventilation, justifying my choice. I found this tutorial approach very helpful.
As a middle grade doctor, I could be called upon to explain some of the clinical features of a disease, such as diabetes mellitus, to some junior colleagues. I would adopt the above approach with the colleague in a one-to-one situation and start by establishing the level of the colleague’s understanding of the relevant disease. From this, I would then lead them through any areas of poor understanding, before reviewing a number of selected cases so they can see why the disease leads to the presented clinical features, and the effect these have on a patient’s life. Finally I would present them with new cases to establish their understanding after the teaching, reviewing their answers with them.
As this is a difficult situation, taking place in a semi-public arena and involving a senior colleague, I would ask my distressed colleague if they were alright to continue or if they needed some time out to compose themselves. Before moving on I would reassure the patient regarding the minor error, and would check that the ward round notes were written up correctly, such that patient care was not adversely affected by this incident. After the ward round, I would approach the registrar and politely suggest that whilst errors need to be corrected, they should consider how they present their comments in front of patients.
My colleague should discuss this error with the registrar in order to learn from it, and request the registrar to discuss any failings with them privately rather than in front of others.
Were I to be the registrar, I would correct the error to ensure patient safety and good treatment. After the ward round I would discuss the matter in private with the foundation doctor explaining why the error could have caused problems. I would offer appropriate help e.g. individual training or tutorial to improve their understanding and prevent recurrence of the error.
Having observed the procedure several times, I was, under supervision, taking my first blood for culture, using aseptic technique. My setup was less than ideal. I contaminated equipment and had to replace it and start afresh. The supervisor took me aside and discussed the problem, emphasising the need for thorough preparation. They suggested that I plan carefully, listing the equipment required and checking I had collect it all prior to starting. They also demonstrated techniques for putting on sterile gloves without contaminating them. Overnight I read up the procedure and consulted the local protocol. The following day, the registrar asked me to repeat the procedure on another patient. I referred to my notes and the protocol, collected the required equipment, double checked it, and completed the procedure successfully without wastage or contamination.
I adopted this approach of observation, pre-reading, reference to local protocols and making notes for common procedures in this and subsequent placements, and have found that it increased my confidence and success at performing procedures. In foundation training I would continue with this approach to new procedures, consulting textbooks, familiarising myself with local protocols and carefully observing senior colleagues practice and amending my notes accordingly.
