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Performance: trainer role - case study
Medical SHO
Case studies are fictitious but based on CDU experience.
Dr RT was a consultant physician with responsibility for three Foundation trainees, three SHO's and two SpR's. He was approached by one of his consultant colleagues with concerns about one of his SHO's, Dr PF who had been on take with him over the previous weekend. She had not turned up until lunchtime on Saturday but had not phoned so there was no response when the arrest bleep went off. When she did turn up she said that she had had a migraine. Later that evening the SpR found that Dr F had developed a backlog of patients to be seen in the medical assessment unit and was not responding to her bleep. On enquiry she said she felt all right. One of the other SHO's said she was always like this.
Dr T realised he knew very little about her and their paths had not crossed at all. He called her in and asked her what had happened. She was very sorry, she had had a migraine and her mobile had not been charged. Yes, everything else was going fine. Yes she understood what she should have done.
A week later one of the senior nurses mentioned that Dr F had upset a patient and their family by muddling them up with another patient and informing the patient that he had had a stroke. She had refused to apologise to the patient. The senior nurse went on to say that she seemed unable to make a decision and the nurses had learnt to check her prescribing as several 'mistakes' had been noted. The nurses had learnt to bypass her and go to the registrar.
Dr T arranged for her to work beside him in outpatients and gave her some new patients to see and present to him. Dr F provided a very muddled history and Dr T had to see the new patients himself and start again. By the time he had finished Dr F had gone, although he had asked her to stay on so they could discuss the patients.
The next day Dr T, by now quite concerned, asked the clinical tutor for help and advice. Dr T thought that patient safety could be at risk and he was going on holiday for a fortnight the next day. The clinical director of the unit was then consulted who thought that Dr F should only be allowed to do work completely supervised. Human resources then became involved and it was arranged that she should only do outpatient work under complete supervision. She was called in to see Dr T and a representative of the Trust HR that evening. She seemed angry and upset at the news and the next day called in sick.
When Dr T came back from holiday Dr F was still away sick but Human Resources were concerned as she had not sent in any medical certificate. It was arranged for her to see Occupational Health, who said that she was fit for work.
In the meantime Dr T had decided to refer her to the CDU and while trying to give a report to the CDU, reviewed her original CV and job application. Dr F had previously worked for a colleague in another county so he rang and found that she had been an excellent SHO until the accident happened - what a tragedy.
Apparently her parents and brother had been killed in an RTA nine months previously and she had taken the last month of her previous job off,on compassionate leave.
Dr T asked to see Dr F at the end of the afternoon and allowed more than an hour. She agreed that since the accident she could not concentrate and had crises of confidence. She was finding it difficult to sleep and kept feeling anxious. When asked why she had not gone to her GP she said she did not have one and when asked about Occupational Health she said she had thought that if they put her off sick she would lose her income and therefore the small flat she rented.
Dr T arranged for Dr F to see a GP local to her and she was off work for two months. On her return she was seen by Occupational Health, who helped arrange a gradual return to work. She was seen by the CDU coach and a plan was drawn up to ease her back into work responsibilities at a rate she could cope with. The Postgraduate Dean agreed for Dr F to have a three-month supernumerary training post and Dr T agreed to be her responsible trainer. During the three months Dr T arranged for one of his SpR's to act as her mentor and also supervised her work personally in outpatients. She attended a Deanery communication skills course.
At the end of the three months formal feedback was sought from 14 of her professional colleagues and the SHO 12-point rating scale was used to review her performance. Dr F passed the criteria that had previously been set for her to demonstrate competency and is now established in another SHO post full time.
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