04.15 - Debrief of Emily and Melissa

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From the course by University of Michigan

Teaching and Assessing Clinical Skills

127 ratings

University of Michigan

Teaching and Assessing Clinical Skills

127 ratings

The purpose of this course is to improve feedback, clinical teaching, and assessment of clinical skills.

From the lesson

UNIT 4 - ENTRUSTMENT AND AUTONOMY

The objectives for this module are that after you actively engage in the activities, you will be able to: 1. Describe the factors affecting autonomy 2. Be prepared to navigate the barriers to entrustment 3. Understand how to appropriately facilitate resident autonomy and grant trainee suitable entrustment of patient care to enhance education.

04.00 - Unit 4 Introduction 1:00

04.01 - What is Entrustment? 6:23

04.02 - Entrustment From Residents Perspective: Dr. Josh Glazer First Experience 1:43

04.03 - Entrustment From Residents Perspective: Dr. Josh Glazer Second Experience 3:28

04.04 - Entrustment From Residents Perspective: Dr. Ashley Pavlic 9:47

04.05 - Faculty Factors Affecting Entrustment 16:20

04.06 - Other Factors Affecting Entrustment13:29

04.07 - Entrustment in Vitro 0:58

04.08 - Josh and Emily 1:05

04.09 - Debrief of Josh and Emily 3:06

04.10 - Joe and Morgan 1:42

04.11 - Debrief of Joe and Morgan 2:44

04.12 - Emily and Morgan Evaluating Patient with Chest Pain 1:10

04.13 - Debrief of Chest pain - Emily and Morgen 1:57

04.14 - Melissa and Emily and Pediatric Resuscitation 1:02

04.15 - Debrief of Emily and Melissa 4:05

04.16 - Bedside Rounds 1:07

04.17 - Debrief of Bedside Rounds 1:53

04.18 - Rounds 2 0:54

04.19 - Ben and Team CPR 1:32

04.20 - Debrief of Ben and Team CPR 3:50

04.21 - How Do We Entrust? 0:52

04.22 - Dr. Andy Oden 9:18

04.23 - Dr. Meg Wolff 3:45

04.24 - Dr. Michelle Caird 11:39

04.25 - Tips to Entrustment 9:00

Meet the Instructors

Sally Santen, M.D., Ph.D.
Associate Professor - Emergency Medicine
University of Michigan Medical School

Oh my goodness.

>> [LAUGH].

>> That's a really tough one.

>> Yeah. >> because we've all been in that place.

>> Absolutely.

>> Yeah. >> So

tell me what, what, so what, I guess let's start with what does she do well?

So Melissa is a advanced pediatric fellow and

is supervising Emily who is a fourth year emergency medicine resident.

So almost. >> Yeah.

>> Ready for practice.

And so I guess let's think first about what did Melissa do well with that?

You know, I think in the beginning they knew what they were expecting,

so Melissa let Emily get everything that she needed, and you know,

briefly said, do you need everything?

But didn't hold her hand in getting everything.

She assumed that as, as an advanced learner that she'd be capable of that.

And it appeared that Emily as going to have an opportunity to

manage the airway so I think that part was done well.

>> Yeah, and you had just sensed that Emily was ready,

she had been getting ready, she kind of had talked about how she was going to

approach it, we knew that she had enough experience.

>> Absolutely, and

Emily was standing at the head of the bead and Melissa was off to the side,

it was very clear who was going to be the person to sort of intervene.

And then.

>> And then.

>> The patient arrived and that whole thing changed.

>> Yeah. >> You know, Morris sort of

pushed her out of way and said I got this, you know.

And, and basically treated Emily like she's a respiratory therapist.

>> Yeah. >> Just asking for things.

I can understand how that would happen,

because we also have to consider a patient's safety when we are you know,

dealing with issues of, of autonomy and trustment.

But I think there is probably better ways to do it than that.

>> In some ways, you know.

To stabilize the patient by giving the baby some oxygen.

>> Yeah.

>> And taking a deep breath, and.

>> Right. >> That would be totally appropriate,

I mean she didn't even give her the opportunity to try to do anything.

>> Yeah. >> You know, it's not as if Emily had

tried to do something and, and the baby was, was continuing to decompensate, or

that Emily was doing something improper, you know, that.

The baby landed on the bag, and Melissa literally took over and

pushed her out of the way, so.

>> And I think, I think, that there are situations where,

where, as a supervising position, you have to, because of the patient's safety.

Like in this case, she really could have, you know, stabilized the patient,

given oxygen, given Emily a chance to try, really just kind of let her do it.

Absolutely.

You know, the baby did arrive >> Mm-hm.

>> With a stat of 70%,not good.

But, but she didn't give her the opportunity to, you know, Emily, very well

may have put some oxygen on her, get her stats up before an attempt was tried.

>> Yeah.

>> You know, I think, I think there was a, a, at least a few

seconds of room where she could have given her an opportunity to try something.

>> Yeah. >> With Melissa standing right

there as back up.

>> Yes. >> In case something happens.

>> Yeah.

And so I think so I think, as I go back and think about this,

if it had been an intern, then I probably should have walked through the intern what

the steps of what we were going to do, but position myself in Emily's place.

>> Absolutely.

>> With the intern helping me bag and get things ready.

>> That'd be great.

And Melissa knew coming in that this was a really sick kid, and should have

kind of judged beforehand what she thought the level of autonomy was for Emily.

>> Yeah.

>> And instead, she kind of judged that it was okay,

because she wasn't really thinking about how sick the kid was.

>> Right. >> And she needed to make that decision,

probably early on in this case.

>> Right. Because the way that it

happened completely undermined any.

Sort of autonomy Emily felt like she had in that situation, or

any responsibility for it.

>> Yeah, that's, that's, that's a tough one.

So I think really kind of thinking through what it is.

And then I honestly think that,

I think that as young attendings, we get really anxious.

>> Absolutely.

>> And it's easier to kind of take over and

do it ourselves than kind of step back and take a deep breath.

That sometimes the stepping back, and deep breath,

we really have to force ourselves to do that, rather than taking over.

It's a tough one.

>> Yeah, it is, it is, yeah, I think, I think that's a good point though,

we need to be very cognizant and

deliberate about, about when we're, when we're intervening on something like that.

>> Yeah, agree, all right, let's watch another video.

>> Great.

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