Registrar in crisis

Question 1

Discuss approach to dealing with registrar with complaint made against them

Answer 1

1) have meeting
- privacy, enough time, no interruptions
2) present allegation/complaint
3) ask for their viewpoint
4) check if okay/confounding circumstances
5) if allefation true
- state is unacceptable (if appropriate)
- work out a solution (apology, time off, retraining)
- consider notification (DEM, DEMT, Hosp Exec, ACEM, APHRA)
6) offer supports ( psych/mentor etc)
7) Follow-up

Question 2

List Mandatory reporting for impaired health care practitioner

Answer 2

1) practising whilst intoxicated by alcohol or drugs
2) sexual misconduct in the practice of the profession
3) placing the public at risk of substantial harm because of a health impairment
4) placing the public at risk because of significant departure from accepted professional standards

Question 3

Discuss signs of a registrar having difficulty

Answer 3

1) disappearing act
- not answering phones or pages,
- disappearing between clinic and the ward
- frequent lateness
- excessive sick leave

2) low work rate
- slowness at procedures, clerking, compeleting letters and making decisions; comin early and staying late but still not getting a reasonable work load complete

3) Ward rage
- aggressive or passive aggressive responses when decisions are questioned
- shouting match with colleagues or patients
- disrespectful or dismissive speech and behaviour toward other heath professionals

4) Rigidity
- poor tolerance of abiquitiy
- inability to compromise
- difficulty prioritising
- inappropriate or vexatious complaints

5) Bypass
- juniour colleagues or nurses finding ways to avoid seeking their opinion or help

6) Career problems
- difficulty with exams
- uncertainty about aceer
- disillusionment with medicine

7) insight failure
- rejection of constructive critism
- defensiveness
- counter-challenge

8) departure from protocols and safe procedure guidelines

Question 3

Discuss signs of a registrar having difficulty

Answer 3

1) disappearing act
- not answering phones or pages,
- disappearing between clinic and the ward
- frequent lateness
- excessive sick leave

2) low work rate
- slowness at procedures, clerking, compeleting letters and making decisions; comin early and staying late but still not getting a reasonable work load complete

3) Ward rage
- aggressive or passive aggressive responses when decisions are questioned
- shouting match with colleagues or patients
- disrespectful or dismissive speech and behaviour toward other heath professionals

4) Rigidity
- poor tolerance of abiquitiy
- inability to compromise
- difficulty prioritising
- inappropriate or vexatious complaints

5) Bypass
- juniour colleagues or nurses finding ways to avoid seeking their opinion or help

6) Career problems
- difficulty with exams
- uncertainty about aceer
- disillusionment with medicine

7) insight failure
- rejection of constructive critism
- defensiveness
- counter-challenge

8) departure from protocols and safe procedure guidelines

Question 4

Discuss approach to management of registrar not coping

Answer 4

1) obtain information
- term supervisior
- DEMT
- Nurse manager

2) Initial discussion with trainee
- to act in accoradance with principles of natural justice and procedural fairness, to help you gather information you need to make an assessment, to give the trainee the opportunity to respond to and resolve the issues before it progresses further
- Ensure approrpaite place and time, decide what needs to be covered in initial meeting, have relevant infor handy, thank about possible solution prior to meeting, anticipate that the trainee may be initially defensive or upset
- explain purpose of meeting, listen to trainee side, gather information
- set short term goals
- document the important aspects of the discussion and outcome

3) identify the problem and the potentional solutions
- clinical knowledge and skill (deficit, in knowledge or procedure, poor comunications, poor documenentation)
- Behaviour and attitude
- health (acute or chronic physical health problems, emerging or chronic mental health problems, substance abuse or dependence)
- Environment

4) Agree on an action plan and review date
- spend some time exploring areas of strength
- Be specific about objective and time frames ( specific, measurable, achievable, realistic and time bound)
- Act in trainees best interest by clarifying your intent “my job is to support you to be successful in the term”

5) implement plan
- Action to correct knowledge deficit - recommend specific text or review articles
- ensure easy access to helpful tools including handbooks, protocols and the clinical information portal
- Trageted supervision - buddy system, prescribing review, ecg review and cxr review with seniour, supernumerary position if required. Increase suport
- communications workshop , sim lab, psych support, referral (Gp, psych, phycision)
- career counselling or assessment

6) review and resolve
- review, discuss whether still required, if so set new goals and timframe and new approach to achieving them

Question 5

Discuss graded interventions that can be implemented for a junior doctor struggling

Answer 5

1) contemporaneous
2) ED supervisor
3) hospital JMO manager
4) Hospital Admin
5) Aphra