Communication Vivas

Communication station

Communication station

Communication viva

Communiction viva

Communication

Communication viva: the intentional overdose patient

Communication viva: family angry regarding inappropriately aggressive treatment

Communication: brain death in a pregnant patient

Zachary is a previously well 19-year-old male admitted to your ICU three days ago with refractory status epilepticus. No infective cause has been found and the working diagnosis is auto-immune encephalitis.

A 30 - year - old haematology inpatient, Donna /David Smith was transferred to your intensive care unit with neutropenic septic shock 4 hours ago. She /he received induction chemotherapy 14 days ago for newly diagnosed Acu te Lymphoblastic Leukaemia.

You have just started your week on duty as the consultant. On handover you have been advised that the family representative is coming in for a discussion today about George. George is a 67-year-old man, day 7 after resuscitation following an unwitnessed cardiac arrest.

You are the duty Intensivist arriving for the first day of your ward service week. One of your patients is a previously independent 60 year old female, Mrs. Jane Smith, who was admitted 5 days ago with community-acquired pneumonia.

The Senior Registrar has just performed a percutaneous tracheostomy, on a 17-year-old female, Ashleigh, recovering from meningococcal sepsis.

You are taking over as the Intensivist on for the week and you meet with Chris who is the next of kin of 59 year old Pat, a patient in the ICU. Pat was admitted to hospital with dysarthria and limb weakness.

John is 64, and is a committed Jehovah’s Witness admitted to ICU following surgery for colonic bleeding, with an admission Hb of 42g/L.

You are the Intensivist in a tertiary metropolitan unit caring for Mr John Wilson, a previously well 45 year old man who has suffered a devastating neurological injury as a result of a subarachnoid haemorrhage.

You are asked to speak to the parent of a 21-year-old male, Kevin Smith, who was readmitted to your ICU last night. He was originally admitted to your ICU with a severe traumatic brain injury 4 months ago. He had aggressive treatment including a decompressive craniectomy.

Mr Soul is an 82-year-old man who, despite severe dementia, has been living at home with his elderly wife. He is fully dependent for activities of daily living and was assessed last year as requiring high-level nursing care. He was admitted to your hospital 2 days ago with drowsiness.

You have taken over the care of Matthew, a 28 year old male, admitted to the Intensive Care Unit overnight following a motor bike accident. His GCS was 3 at the scene and was intubated and ventilated by the paramedics.

Mr Smith is a 54 year old male who was admitted to the ICU 7 days ago. He presented with severe hypoxic respiratory failure and has a background of advanced motor neurone disease. He is currently unconscious, intubated and ventilated. Mr.

You are the Intensivist  on call, working with a new ICU Registrar who is in the first year of Advanced Training. This is your first shift with this trainee but your colleagues have found him/her to be competent.

You  are the  intensivist  caring for Mrs June  Hay,  a  56 year old  lady  recently  admitted comatose  to  the  ICU  following  a  subarachnoid  haemorrhage,  but  who  had  made  good progr

You are the intensivist caring for a patient Mr James Wilson, a 70 year old man admitted to your ICU last night with aspiration pneumonitis associated with a bowel obstruction. He had been in hospital for 4 days prior to admission to the ICU.

You are the intensivist on duty in the Intensive Care Unit where a 15 year old boy (John) is critically ill having been a pedestrian hit by a motor vehicle.

The following scenario was given to the candidates.

Mr Horomia, age 76, a bachelor of Maori extraction, was brought by ambulance to the ED today with hypercarbic respiratory failure. He was intubated, and is now sedated and ventilated in your ICU. His problems are:

Communication station: The scenario  was as follows:

Joanne, 60 years old, was admitted to intensive care with severe community acquired pneumonia. After several days of instability, she began to improve. Her only daughter, Mary kept a vigil at her side, sleeping in the waiting room overnight.

The clinical scenario provided was as follows:

As for communication stations in general, candidates were expected to provide an empathic explanation of the situation, using appropriate body language, and appropriate attention to the needs of the daughter. Other factors looked for included delineation of next-of-kin, expressed wishes,

As for communication stations in general, candidates were expected to provide an empathic explanation of the situation, using appropriate body language, and appropriate attention to the needs of the wife.

Communication station:   Candidates were expected to provide an empathic explanation of the situation, using appropriate body language, and appropriate attention to the needs of the mother. The clinical scenario provided was as follows:

“You  are  the  ICU consultant  today after  a  2-week break.    Your  Intensivist colleague yesterday arranged this family meeting with the daughter of your patient Mrs Pearson. Mrs Pearson is a 78 year old lady who has been in ICU for 2 weeks.

Scenario: A 22 year old girl had chemotherapy and bone marrow transplantation for leukaemia.. While waiting for marrow recovery she develops hypoxic respiratory failure requiring admission to your Intensive Care Unit and non-invasive ventilation by mask with an FiO2 of 1.0.

“A twenty-three (23) year old woman (Jane Bland) was admitted to your Intensive Care

Communication station.  Candidates were expected to discuss the issues surrounding brain death and organ donation with a patient’s next of kin.  Seven out of twelve candidates passed this section

Communication with an  actor  involved discussion of ongoing management of a patient with incurable metastatic disease. Six out of fifteen candidates passed this section. Many candidates need to improve their basic counselling skills.

The presence of a relative during cardiac arrest management. Ten out of fifteen candidates passed this section

Management of withdrawal of therapy.

Communication with an actor involved discussion of ongoing management of a patient recovering from critical illness, and the potential role of alternative approaches

Communication with an actor involved empathic listening, and discussion of management of post-cardiac arrest victim with daughter.

Candidates were asked to provide a mid-term In-training Assessment to a junior ICU registrar (actor) in her first year of training.

Communication with an actor.This involved explanation  to the  mother of a young girl who has suffered a severe head injury and has just been found to have absent brainstem reflexes.

This involved counselling a registrar who was failing to cope with the sudden death of a young patient.