Question # 1
Describe a clinical case you have observed where there has been a multi-disciplinary approach to discharge planning. Describe how the interactions between the multi-disciplinary team impacted on the quality of the patient’s care. What have you learned from this experience about effective multi-disciplinary team working and how will you put this into practice as a foundation doctor?
Answer #1
While I was on rotation at a spinal cord injury unit, I came across a patient asking for an early discharge due to a personal commitment, despite an unfinished rehabilitation program, active bacterial gastroenteritis and a healing foot ulcer.
I immediately took action, made notes and discussed this with my supervising physician; I took a lead on this and organized a staff meeting in which a consensus has been achieved between the PM&R specialist currently coordinating the patient’s rehabilitation and ward Internist responsible for the active infection and podiatrist, and the below mentioned actions were taken.
A home based rehabilitation plan was created (All involved)
Proper adjustment of antibiotic dosage done (fully coordinated with ward pharmacologist to ensure the patient gets medicines appropriately at home.)
Arranged a dressing for the foot ulcer. (self-involvement only)
Inference - Excellent Communication Skills of specialists, clear verification of patient’s treatment goals, responsibility awareness and proper planning with stepwise approach, strengthens the trust developed by the patient that he will be treated successfully.
Therefore, my experience has made me understand the need and importance of multi-disciplinary teams and I know how to take notes and use the recommendations of the group to take the right decision related to the patient’s health.
Question # 2
Learning happens in a variety of contexts, some of which are opportunistic and some of which are planned.
* Describe a clinical situation which provided you with an opportunistic learning experience. What approach did you take to consolidate and extend this learning? Compare this approach to how you may follow up a planned learning experience. How will you use these experiences of learning to improve the quality of teaching others?
Answer # 2
While working on research in hospital early in medical school I have been called in unexpectedly to help with patient intubation due to momentary staff shortage.
After I had analyzed available guidelines and reviewed available literature in order to gain knowledge on alternative approaches to intubation using online and offline resources, I have practiced the technique on manikins provided to me by the University Anesthesiology department under supervision of a Anesthesiologist in my free time. Later on, to still gain as much skill as possible I attended overnight shifts in the ER where occasionally I had the privilege to intubate several patients under supervision.
Planned learning experience would require from me to regularly attend the departments in which I could obtain a chance to perform or observe intubation and other procedures on a regular basis. I also try to analyze the latest Medical Journals in order to keep up with current suggestions, new techniques and other issues that could improve my skills.
I will closely involve the students to the cases that are directly linked to their current area of study and will ensure that I get the nursing to contact them along with a senior doctor to help, so that they get an opportunity to learn. Moreover, I will create planned experience for them by distributing them the case studies of different patients and would ask them to supply me with notes on that topic.
Question # 3
Being able to prioritise tasks is an integral competence of a practising doctor and may be challenged by many factors.
* You are the only foundation doctor on a busy surgical ward, and you feel under pressure to complete the tasks expected of you. A foundation doctor from another surgical team asks if you will hold their bleep for the second time this week as they want to go to theatre to observe an operation. What would your initial response be to your colleague? What factors would influence this response? If you had to hold the bleep, how would you prioritise the tasks? What additional learning needs does this situation highlight for you?
Answer # 3
I would be glad to help and definitely agree to take on the responsibility however I would inform the person that I am already busy with another surgical ward and need a proper handover (emergency contacts, case specific details etc.) before I actually start managing the same.
Furthermore, the opportunity to see more patients creates possibilities for me to (improve) my time managing and decision making skills and these are the backbone of a good healthcare unit. My focus will be to work on quality improvement through regular analysis and I would study the notes each day to figure out what could have been done better? I will ensure that my team participates in a short huddle together each day to share our experiences and the best practices used.
I would prioritize my medical emergencies from most acute and life threatening to ones that require less urgent interventions due to less life threatening nature. Scheduled operations and procedures would be carried out depending on severity of symptoms and overall patient condition (appendectomy in a patient with abdominal pain over routine colonoscopy in asymptomatic patient). It is very important for my patients to know me so will maintain a regular interaction with them.
Question # 4
Communicating information to patients can be a complex undertaking.
* Describe a clinical consultation that you have observed where the specific cultural, social or family circumstances of the patient posed additional challenges. Identify the techniques used within this consultation that contributed to this patient’s experience. What other approaches could have been used in this situation? What did you learn from this which you can apply to your future clinical practice?
Answer # 4
During an overnight shift in the ER a 5 year old boy was admitted due to severe abdominal pain due to appendicitis. Unfortunately his Mother was abroad, his father had no parenting rights and his current legal guardian did not have consent to treat (surgery couldn’t be done at that moment). Immediate staff meeting was held, in which it was decided that surgery is the most appropriate modality at the moment despite missing consent forms, and inability to contact the mother.
Most impressive was the calm and reassuring approach of the attending physician, who reassured the patient and his supervisor to provide the best possible treatment despite challenges, and ensured that we have proper documentation related to the patient’s condition (reports etc) so that the urgency to do the surgery can be proved later on(if questioned).
Conservative management has been considered during the meeting until the child's mother could be reached however, due to severity and symptom duration immediate surgery has been chosen due to possible risks of prolonging the waiting period.
A laparoscopic approach has been chosen over open surgery due to lower post op complication risks and shorter hospitalization course ultimately ending in success.
It is essential to realize that the patient's well being is always the highest priority and the best we can do is to collect as many documents as possible to prove that the decision taken by us was right giving the situations.
Question # 5
Essential attributes of a foundation doctor are the ability to deal effectively with pressure and the ability to prioritise tasks.
* Describe two different personal achievements to demonstrate that you possess both of these qualities, relating each achievement to a single attribute. For each attribute, give one specific example of how your achievement can contribute towards improving your performance as a foundation doctor.
Answer # 5
I was looking after the surgical ICU with 4 patients needing critical care, there was a need of regular suctioning for two, BP monitoring for three, all four of them were passing urine on bed and required dressing of wound after eight hours each. Considering that I had only one support staff with me, I used my experience to shift them according to their needs into twin-sharing rooms, I managed the suctioning of the two patients from one room, while the other two were monitored for BP by my staff, I also got in touch with another ward teams, to ask for volunteers to help me for an hour after their shifts were over and I got a couple of them. Since, I had notes with me that I had made related to the cases it was very easy for the support staff to understand what needs to be done. This has given me a great lesson that we need to think end-to-end and plan in pressure situations, we may want to stretch of give overtime etc. but the patient’s health cannot be at stake.
There was a situation where I was along with a group of patients (9 in total) who were suffering from food poisoning and I had to plan their treatment, since it was difficult to monitor them together. I immediately fist did very common tests (BP, ECG and Sugar) to understand the criticality of each of them and started the treatment accordingly, and was successful in saving all of them within a span of eight hours with the help of my team. This success has given me great confidence and I have included it in my general practice to start with common tests and them prioritize the treatment accordingly.
