Behavioural Questions Flashcards
What was the worst medical experience you were involved in?
S
- 71M COPD presentation in respiratory distress, ALOC, no collateral history
- On rural, 1 PHO, 1 SMO who was superintendent and medical student (me), 2 nurses
- I escalates to SMO who walks in, says ‘just palliate’ and walks out
T
- Not comfortable palliating without resus efforts and no ARP
- Team - focus on acute stabilisation and retrieval
- Me - Assist seniors with tasks
A
- PHO runs resus, good leader. Bipap started.
R
- Patient deteriorated
R
- clinically well managed but no support, no communication, no consideration of patient wishes
- i should have re-escalated using graded assertiveness
- calling RSQ earlier for advice
- debriefing
- This PHO was a role model to me as a leader and manager - remaining calm, systematically managing and delegating tasks effectively.
What was a good medical experience you were involved in
S
- Rural rotation in Longreach, 31F deep hand lac following motorbike v barbed wire fence
T
- Laceration required discussion with ortho and then able to be closed in ED
A
- Given hand splint to keep tension of sutures, would have to be in this for 1-2 months
- Discharged, patient happy with plan
- Medical student had been chatting to patient, lives on a property, recently bought a new horse, unset she wouldn’t be able to ride it and that he wouldn’t get exercise
- Medical student was a horse rider, so she invited her to the property to ride it
- I found out about this later and am also a horse rider so asked if I’d be able to come which she was happy with
R
- Went out to the property, children was very thankful for what we had done
- Had lunch and rode the horses, found out that she was struggling with a few other tasks on the property such as taking hay to the cattle (very heavy bails) for which she was very grateful
R
- During the placement had multiple visits, able to check the healing of her wound and do dressing changes to save her a long drive into town, as well as enjoy and appreciate the farm lifestyle out west
- Made me appreciate how her treatment impacted on her lifestyle, a factor that I had not considered initially. I learnt a valuable lesson from this is considering the specific situation of the patient and how this will impact their healthcare
- Very rewarding experience being involved in initial treatment and follow up and tailor this to the patient’s specific needs
- Felt much more connected to the community than with providing care in the city
- This, in combination with many other positive experiences on rural placements throughout uni and residency re-affirmed my plan for working rurally in future
Describe a situation where you had a conflict/disagreement with a colleague. How did you handle it?
S
- renal, nurse insisting on taking out 6 day old cannula, patient on IV ABs
T
- unable to cannulate at time
A
- Explained would do it after rounds and that the cannula was required to stay in for anti-biotics.
- Nurse raised her voice, replying: ‘that’s your job not mine, I’m taking it out right now’
- I remained calm and reoriented job as a team to provide the care to our patients, needing ABx
- Usually collegial with this nurse so I asked in a supportive way if anything else was going on
- she was getting pressured from our hospitals IV access team and she recently had a patient develop possible line associated sepsis
R
- reached agreement to stay in for now and I would come immediately after rounds
R
- When I returned, the nurse was very apologetic about raising her voice and I reassured her that she was doing what she thought was best for the patients which is most important
R
- demonstrate collaboration and conflict resolution by staying calm, understanding her perspective, reorienting discussion to team goals and negotiating
Tell me about a time when you were overwhelmed or scared by a clinical scenario. How did you deal with it?
OR
Describe a clinical situation where there was an emergency at work and how you responded?
S
- Rural rotation. First ever solo on call shift overnight. Call from nurse - QAS have 68M ROSC post cardiac arrest in car. No known history.
- On arrival appears unwell, profusely sweaty, respiratory distress, chest pain.
T
- Me and 1 nurse present. Limited resources. Nurse clearly anxious
A
- Maintained a calm composure
- While donning COVID PPE I informed the nurse of differentials of concern e.g. MI, PE, sepsis and delegated priority tasks such as attaching oxygen and monitoring and taking a venous gas and glucose while I assessed the patient
- Provided an opportunity for the nurse to raise questions and concerns, attempting to establish an environment where she could raise concerns without hierarchical barriers
- Performed structured primary examination, continually informing my nurse of what I was doing, to establish a shared mental model
- Following this assessment discussed with my consultant, providing a concise handover of pertinent features on history, exam and investigations, my differentials and management thus far. Reassured by improving vitals and relatively normal iSTAT bloods my SMO decided not to come in, which I was
R - Improved respiratory distress with oxygen, remained stable overnight. After formal investigations in the morning was diagnosed with CAP
R
- Debriefed with the nurse once the patient was stable, to reflect as a team on what worked and didn’t work
- Commended by nurse on communicating clearly and keeping her informed
- In addition to delegating tasks, utilizing this shared mental model allowed her to identify tasks she could do to help and enable her to feel able to raise concerns, maximising the efficacy of team members
- Remain calm to help in still calmness in followers
- Logical system to fall back on when stressed
- Recognise limits and escalate early
Here I demonstrated leadership though clear communication, delegation of roles, creating a calm environment and recognising my limits and escalating early.
Can you tell us about a mistake you have made and how you dealt with that?
PE
Cuff up extubation
Cultural competency - pregnancy diagnosis ED sister in room
S
- 40F Indigenous patient with abdominal pain
- Positive urine pregnancy test
- Sister in room, thought this would be a good support person, womens business. Don’t know why I didn’t ask
T
-
A
- patient asked sister to leave
- Apologised, answered questions
- Escalated mistake to SMO
- consultant helped discuss treatment option and offered to discuss with any other family members
R
- Thanked us for taking the time to discuss options with her
R
- Recognised the importance of checking who the patient wants in the room and respecting privacy, especially for different cultural groups
- could lead to mistrust in health system and shame from family
Describe a time you went above and beyond for a patient?
Rural
- hand stitching, talked with patient while doing it and understood the impact it would have on her
- offered to hep muster cattle (rural background, can ride horses and muster)
- able to see how they lived
- incredibly rewarding experience, patient very thankful, no similar city experience
R - developed an appreciation for how conditions impact patients and while we can’t do something like this for everyone I make a much greater effort to understand their situation and tailor treatment or find solutions where possible
- also pivotal experience in enjoying rural medicine and being part of the community
S
- 16F lupus nephritis end stage renal failure
- From PNG, no medicare, dialysis will be stopped in 2 weeks
- Team decision that she was going to have to travel back to PNG for ongoing treatment
- Parents working full time, unable to move themselves due to financial restraints, extended family in PNG but patient hadn’t been there since very young, clearly distressed by the idea
T
- Alleviate anxiety
- Facilitate safe transfer of care
A
- Discussed with seniors what could be done, had already made efforts to extend as long as possible
- I could help by arranging a referral and initial appointment to prevent loss to follow up and reduce her distress
- Hours on the phone, multiple disconnects, multiple facilities at dialysis capacity or no dialysis available
- Eventually got an email address of a consultant who I contacted with a referral letter and was willing to treat her
- Explained referral to patient, able to give her a location and appointment time. Very happy about having definitive care organised
- Got back paperwork from PNG hospital which I helped her to fill out as her parents where unable to come to hospital to help her due to work requirements
R
- Significant relief for patient, safe care organised
R
- Ensuring patients are know how to access healthcare, especially culturally and linguistically diverse groups
- Difficultly culturally and linguistically diverse groups may face trying to access healthcare in Australia for the first time. Importance of ensuring they understand appointment details and importance of appointment to avoid loss to follow up
- Humbling and rewarding to make such a difference to a patient, even if I’m not the one treating her condition
Talk about a time you received constructive feedback?
S
Pre-occupied with grand rounds presentation, rushed pre-meds and grand rounds ran late so late to theatre
T
A
Apologised for tardiness and explained reason
Was expecting to get criticised regarding my tardiness and poor quality handover
R
Consultant feedback that It was fine for that to happen but I needed to inform her of situation
R
Realised that being on top of my game 100% of the time isn’t possible, especially with unpredictable workload in medicine, and that what’s important is keeping colleagues informed on factors that may be impacting my performance, rather than trying to manage everything independently
May face situations such as fatigue in future, and it is important to communicate this to others, rather than trying to keep quiet and work as though it isn’t affecting me
Recognised that others will often not be critical of me expressing limitations to my ability but instead rather be informed on these factors
Talk about a time you had to handle a difficult/abusive patient?
Crazy maxfacs Telehealth.-
- calm
- apologised for difficulties, explained how I had been trying to find solutions
- allowed patient to express frustration and acknowledged her frustration
- not tolerant of insults
- redirected conversation to issues we could address
- explained findings calmly
- escalated to consultant
S
- Renal, 60M ESRF on peritoneal dialysis. Questions around capacity ?intellectual impairment ?delirium also on parole, recently released from prison
- Attempted self discharge most days, had previously been brought back in police custardy after leaving ward
- Today had made it off the ward to the lifts, insistent on leaving
T
- Verbally de-escalate to prevent potential harm to patient as he was not able to perform own peritoneal dialysis at home
- further frustration/mistrust with healthcare system due to police involvement
A
- Engaged patient from a distance in a calm, non-threatening manner
- Initially patient not wanting to engage in discussion, was able to build rapport by discussing his plans once he was out of hospital, learning that he was keen to move to northern NSW to spend time with his son.
- This allowed me to better engage him him as he would frequently avoid discussions regarding his health
- When appropriate, asked why he wanted to discharge, to which he stated he was sick of being in hospital, and that he thought our agenda was to keep him here indefinitely just like in prison, believing he was capable of performing his own peritoneal dialysis, although he had failed this assessment. I could see he was becoming frustrated as he was saying this, raising his tone of voice and becoming more animated in his body language
- I maintained a calm tone and explained his condition and that our intention was not to detain him, but work on a safe discharge. I was relate back to his plans to spend him with his son to emphasise the importance of his health in order to do this, as improper peritoneal dialysis technique could lead to earlier reliance on haemodialysis which would not be possible in rural locations
- This became a prolonged discussion which involved re-explaining things a number of times, but I had informed my team beforehand what I was doing, and so they were aware of my absence and able to keep working to cover me
R
- Eventually the patient agreed to return to the ward without requiring security or police presence
- Following this discussion, I think the patient was much more understanding of his condition, and was more willing to engage in his care. While he did on occasion
continue to attempt self discharge, I was able to de-escalate him with similar techniques and this eventually led to a safe discharge.
R
- I was able to resolve this situation by relating to the patient on his level, using a non-threatening or authoritative demeaner and taking the time to explain the patient’s condition to him in language that was appropriate to him
- I also learnt from this the importance understanding patients individual concerns and expectations, rather than simply their medical needs, and how these impact their care
Provide an example of when you successfully worked in a team
Mater ward call
S
- pneumonia patient with worsening T1RF
T
A
- reviewed patient, started high flow. Communicated with ICU reg possibility of deterioration and planned for admission if worse. Updated ICU outreach for them to monitor and communicated plan to nurses and documented.
R
Later concern raised by ICU outreach, Attended promptly, ABG -> worsening T1RF. notified ICU to organise admission.
Multiple other calls during this time so triaged these over the phone and had nurses/ICU outreach help initiate basic Ix/Rx to streamline, and communicated expected timeframes for reviews due to situation so nurses knew I understood their concerns and wasn’t avoiding the task.
R
- kept team informed
- Planned ahead
- managed staff resources and delegated tasks
- responded to concerns of my team members
Talk about a time you worked with someone you didn’t like
S
- 1st term of internship, me and one other new intern and a JHO on team
- JHO would show up late, frequently would not do jobs that were allocated to him or would say he was going to clinic and leave for a fewa hours, later realised he wasn’t in clinic
T
-
A
- Initially avoided confrontation as I didn’t feel comfortable approaching him as JHO in my first term of internship so I would check his jobs had been done and do any missed with the help of the other intern
- one day he was on rounds in the morning without us two, didn’t check bloods which led to a patient being discharged despite a raised CRP, who was later re-admitted
- when this was noticed by our fellow I apologies on behalf of us 3 and took shared responsibility, in order to prevent a culture of blaming within the team
- I later brought this mistake up with the colleague, indicating I believed he was at fault, and in response he shifted blame onto our third resident, causing her much distress
R
- I was able to support this colleague and for the remainder of the term we allocated him more simple tasks in order to prevent critical errors
- this prevented discord between us spreading to the rest of the team, with our supervisors commended us at the end of the term on working well together as a team, however lead to frustration between us at a resident level
R
- If faced with this scenario again I would bring up my concerns with this colleague much earlier and do so in a more supportive way, probing as to why jobs weren’t getting done and if there was anything we could do such as allocate jobs differently and seek information as to if there was anything affecting his work on a personal or professional level leading to his absences
- doing this early is important as I have learnt due to the unpredictability and high workload of this career it’s not possibly for one to always pick up the slack of another
- it’s important to approach this in a supportive way to prevent a culture of blame within the team, which only leads to further discord without solving any underlying issue
- I have since used this more supportive approach successfully in non-clinical settings such as in my sport team with much success, and am confident I can apply this in a clinical setting if again faced with a similar scenario
Provide an example of a time you demonstrated leadership skills
S
- Rural rotation. First ever solo on call shift overnight. Call from nurse - QAS have 68M ROSC post cardiac arrest in car. No known history.
- On arrival appears unwell, profusely sweaty, respiratory distress, chest pain.
T
- Me and 1 nurse present. Limited resources. Nurse clearly anxious
A
- Maintained a calm composure
- While donning COVID PPE I informed the nurse of differentials of concern e.g. MI, PE, sepsis and delegated priority tasks such as attaching oxygen and monitoring and taking a venous gas and glucose while I assessed the patient
- Provided an opportunity for the nurse to raise questions and concerns, attempting to establish an environment where she could raise concerns without hierarchical barriers
- Performed structured primary examination, continually informing my nurse of what I was doing, to establish a shared mental model
- Following this assessment discussed with my consultant, providing a concise handover of pertinent features on history, exam and investigations, my differentials and management thus far. Reassured by improving vitals and relatively normal iSTAT bloods my SMO decided not to come in, which I was
R - Improved respiratory distress with oxygen, remained stable overnight. After formal investigations in the morning was diagnosed with CAP
R
- Debriefed with the nurse once the patient was stable, to reflect as a team on what worked and didn’t work
- Commended by nurse on communicating clearly and keeping her informed
- In addition to delegating tasks, utilizing this shared mental model allowed her to identify tasks she could do to help and enable her to feel able to raise concerns, maximising the efficacy of team members
- Remain calm to help in still calmness in followers
- Logical system to fall back on when stressed
- Recognise limits and escalate early
Here I demonstrated leadership though clear communication, delegation of roles, creating a calm environment and recognising my limits and escalating early.
Provide an example of time you advocated for a patient
Urology case in ED
? Severe urinary retention, catheterised but in almost complete renal failure and massive post obstructive diuresis
Registrar scrubbed, not taking phone calls Despite multiple call backs
Escalated to consultant, advocated for them to come review despite pushback
Patient admitted
Consultant called our management incompetent, remained calm, confident I had done the right thing but tried to take teaching from it
Commended by supervisors for escalation
S
- 16F lupus nephritis end stage renal failure
- From PNG, no medicare, dialysis will be stopped in 2 weeks
- Discussed with SMOs, already attempted appeal and had extension, unable to get more
T
- Returned to check on patient after ward rounds
- Anxious largely focused around not know how to access care, not wanting to become unwell again like prior to dialysis
A
- I was organising her referral, made an effort to understand the healthcare system
- Differentiated private from public, facilities with dialysis, how to access, name of visiting nephrologist and days available
- Ensured I had her accepted for care prior to her discharge from PA and exactly where and when her appointment and first dialysis session would be
R
- Explained referral to patient, able to give her a location and appointment time.
- Significant relief of anxiety for patient, ensured safe transfer of care
R
- Learnt difficult of accessing unfamiliar healthcare systems
- Appreciate how this impacts CALD groups accessing care in Australia
- Changed my practice in emphasising importance of ensuring they understand appointment details and to avoid loss to follow up, checking understanding of this and ensuring appointment will be acceptable to patient
- Humbling and rewarding to make such a difference to a patient, even if I’m not the one treating her condition
Despite being unable to advocate to hospital exec on her behalf, I was able to find an aspect of the patient’s care that I was able to address, and do this to the best of my ability, ensuring this arrangement was understood and culturally appropriate for her
Describe a difficult/stressful situation. What did you do?
S
- Rural rotation. First ever solo on call shift overnight.
- Unwell appearing patient, diaphoretic, confused, resp distress.
T
- Me and 1 junior nurse, visibly stressed, limited diagnostic resources
A
- I maintained a calm composure despite internal anxiety
- Donning COVID PPE I informed the nurse of differentials of concern and delegated tasks such as attaching oxygen, monitoring and taking istat bloods while I assessed the patient
- Provided an opportunity for the nurse to clarify this information and voice concerns of her own that I may have missed.
- Performed structured primary examination using an ABCDE assessment to ensure I didn’t miss anything due to my stress. Verbalised my findings along the way, to keep my team informed
- Following this assessment immediately phoned my supervisor, provided a summary of pertinent details and results, my differentials and concerns and proposed treatment. After discussion decided not to come in.
R - Remained stable overnight. Diagnosed with CAP in the morning
R
- Debriefed with nurse. Commended on my communication, keeping her informed and allowing her to identify tasks she could do that I hadn’t necessarily delegated to her and allowing her input, maximising her contribution to the team
- I performed well despite my stress by falling back on a structured system to avoid missing anything
- Escalated early and communicate clearly with consultant
- Remained calm to instil calmness in followers
Empathy
S -
70M mild intellectual impairment, schizophrenia recurrence of gastric cancer.
T -
Breaking bad news - SPIKES
A -
- Before bring the patient in I informed the clinic nurse of the situation to ensure the consult wasn’t interrupted.
- Offered for him to have anyone in the room, built rapport, gauged his level of health literacy and understanding of his condition
- explained in simple language and empathetic tone,
- flat affect - allowed time for him to process, checked understanding, encouraged questions and expression of emotion
- discussed follow up and offered social work referral
R
- saw again in clinics and build good relationship with him requesting to see me
R
- communicator - built rapport, communicated at a level he could understand
- patient advocate - attentive to patient needs, allowing time for the consultant and Empowered him to be involved in his care by improving his understanding and linking with social work
Defend your beliefs/decision making in the treatment of a patient
S
- 16F on rural, tonsillitis
- Nurse had seen patient before me, finding she was febrile and thinking the diagnosis was quinsy
- Nurse took numerous bloods including cultures and explained to the patient and mother she would be required to be in hospital for IV ABs and potentially need to go to Brisbane for surgery
T
- Very soon into my review it became obvious the patient had tonsillitis, with no concerning features for quinsy
- Patient and mother very concerned about previous diagnosis and not wanting to be discharged
A
- I explained the difference to the patient between quinsy and tonsillitis, using plain language, and that the patient’s condition was not dangerous
- Despite this, there was significant ongoing anxiety from the patient and mother, and so i escalated to my consultant to review to confirm the diagnosis, and agreed to monitor her in ED while providing symptomatic treatment
- Over this time I had multiple discussions with the patient and the mother, allowing them opportunities to clarify their concerns, although was unable to convince them that this was a benign diagnosis, as the patient was complaining on worsening pain and fever, despite no new features on repeated re-examination
R
- I later discussed again with my supervisor my difficulty in re-assuring the patient, and we decided we would keep her in overnight to monitor and allow time for her bloods to come back
- I also found a quiet area to discuss this case with the initial nurse, and explaining that her initiative in taking bloods and flagging the patient for review were appreciated, although in future it would be best to avoid distressing the patient about such as concerning diagnosis without medical review. I proceeded to clarify her understanding of the difference between quinsy and tonsillitis, and explain these diagnoses to her. While in the early treatment of this patient the nurse was initially somewhat hostile, urging me to treat this patient with IV antibiotics, after this discussion she apologised for the unnecessary distress she had caused
R
- This incident enabled us to have closer, more trusting relationship, and as a result enhanced standard of care we were able to provide to future patients
