You arrive at work one morning to learn that, overnight, the on-call junior trainee committed a medical error that has resulted in a life-threatening adverse outcome for the patient. The trainee has been waiting for your arrival to talk to you.
Outline the key points of this discussion with the trainee.
Facilitation of an emotional debrief not an operational debrief
Allow the trainee to vent and tell his/her version of events
Remain neutral and avoid criticism/censorship of the trainee’s actions
Ensure there is on-going psychological and emotional support for the trainee
Give him/her the option of time off work or ensure support if he/she chooses to stay
Arrange an appropriate mentor within the department who is not otherwise involved in this incident (may be self or other senior colleague)
Ensure there is back-up from friends/family at home
Offer professional counselling
Advice on:
Open disclosure with patient’s next-of-kin
The medico-legal process that will ensue
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
Need for reporting to coroner if/when the patient dies
Root Cause Analysis of the event by the hospital
Counselling with regards to future career and training
Plan follow-up meeting with mentor and SOT/departmental head for next day
This question is identical to Question 18 from the second paper of 2010.
That answer is reproduced below:
International Critical Incident Stress Foundation
CICM: GUIDELINES FOR ASSISTING TRAINEES WITH DIFFICULTIES (T-13), 2010
Mitchell, Jeffrey T. "Stress. The history, status and future of critical incident stress debriefings." JEMS: a journal of emergency medical services 13.11 (1988): 46-7.
Mitchell, Jeffrey T., and George S. Everly Jr. "Critical Incident Stress Debriefing (CISD) and the Prevention of Work-Related Traumatic Stress among High Risk occupational Groups." Psychotraumatology: Key papers and core concepts in post-traumatic stress (1994): 267.
Bledsoe, Bryan E. "C RITICAL I NCIDENT S TRESS M ANAGEMENT (CISM): B ENEFIT OR R ISK FOR E MERGENCY S ERVICES?."Prehospital Emergency Care 7.2 (2003): 272-279.
Harris, Morag B., Mustafa Baloğlu, and James R. Stacks. "Mental health of trauma-exposed firefighters and critical incident stress debriefing." Journal of Loss &Trauma 7.3 (2002): 223-238.
Laurent, Alexandra, et al. "Error in intensive care: psychological repercussions and defense mechanisms among health professionals." Critical care medicine 42.11 (2014): 2370-2378.