Question 29

You are the appointed welfare advocate for your unit. 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.

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College answer

Not available.


This is a question basically identical to Question 28 from the second paper of 2014 and the Question 18 from the second paper of 2010, except this time you're the "the appointed welfare advocate".

  • The debrief should happen before the affected person has had time to sleep.
  • "Psychological first aid" is the framework that describes the approach to these situations, as what the trainee has experienced is a form of trauma, and 
    • Promote safety and calm:
      • Take the trainee out of the ICU and into a quiet nonclinical area to have this discussion; delegate their clinical responsibilities as well as your own
      • Introduce the process
      • Describe the event, using whatever factual information is available
    • Listen non-judgmentally
      • give the trainee time to discuss their experience and their narrative of what happened (non-judgmental, no interruptions)
      • Allow the trainee (or whatever participants) to describe their cognitive and emotional reactions to the event
      • Help the trainee identify the most traumatic aspect of the event for them
      • Help the trainee identify personal symptoms of distress and explore their emotional reaction to the event, assuring them that their reactions are normal.
    • Answer questions and offer advice:
      • ​​​​​​​Give advice regarding open disclosure process and medicolegal risk
      • Discuss the need to refer to the coroner (if relevant)
      • Educate the trainee regarding normal reactions and adaptive coping mechanisms, helping them find a "cognitive anchor".
      • Adaptive reaction suggestions may include advice on rest, talking to one's friends and family, working with supervisors to initiate procedural changes, dealing with stress through exercise and reflection, etc. This helps the trainee transition back to a cognitive level domain, away from the emotional content of the experience.
    • Promote connectedness:
      • Organise time off work for the trainee, if appropriate
      • Ensure that there are support people available from the extraclinical environment (friends, family)
      • Make an offer of professional counselling
      • Offer to involve an impartial mentor
    • Promote self-efficacy:
      • Discuss with the trainee the need for them to inform their own medicolegal indemnity and defence organisation 
      • Discuss whether the trainee would like to take part in any discussion with the patient or their family
      • Describe good practice for documentation and offer to help the trainee construct a  factual account for their own records



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.