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Performance: self-referral - case study
Non-training grade - A&E associate specialist
This case study, like all the ones on this site, is fictitious but based on typical situations in which the CDU get involved.
Dr OM was working as an associate specialist in A&E. He had held this position for some years and had managed to do the job despite living an hour and a half away. He was responsible for quite a large and
extended family so had never managed to find time to read journals or attend educational events. He felt tired most of the time and very seldom felt motivated at work.
Dr M was told about three different patient complaints over the course of a fortnight. He became concerned and discussed them with one of the consultants in the department. He was concerned to hear that the juniors thought he was unhelpful, unapproachable and never seemed to be there during an emergency. At first he was hurt and upset, but gradually realised that he had begun to avoid emergency situations and also avoided the juniors who seemed to expect him to know all the answers. He went back to the same consultant, thanked him for his feedback and asked him what he could do about it. The consultant told him about the CDU and he referred himself for help.
The CDNA report was revealing - Dr M had begun to lose confidence in his knowledge and skills and had gradually developed ways of reducing his exposure to situations in which he would have been expected to take the clinical lead. He wanted to know whether his knowledge and skills had deteriorated and agreed to discuss his problem with the Regional Adviser in A&E, who arranged for him to test his knowledge with an MCQ. The result was not satisfactory but was not as low as he had feared. He decided to ask the consultant in his department to act as his mentor and a performance improvement plan was agreed with the consultant's help, which included personal reading, courses and a short training secondment to a regional trauma centre.
Progress was monitored by taking a further knowledge MCQ a few months later; this showed an improvement, which gave him a sense of achievement. Dr M began to have more confidence in his clinical judgement and skills. Part of his performance improvement plan included a commitment to teach the SHO's and the feedback on these sessions was also part of the monitoring process.
Finally, after nine months, Dr M sent out some multisource feedback sheets and these indicated that he was no longer considered unhelpful and his presence had been appreciated at some recent emergency cases. Although he still had to cope with the long commute to work, he felt less tired and more motivated at work.
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