Speaking out during trauma resuscitation

[medDaisuki]

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[Nontrad_FL_LGBT]

Time and place imo. I wouldn't be shouting over the attending during a code unless they were doing compressions on the throat or something, but that's just me. Possibly being a distraction during a life and death urgent situation is 100% going to set people off and I can't even say they're wrong tbh.

 

[Lifeblood_20]

I'm sorry that happened. You acted in good faith. I think you probably could've thought about whether the information you wanted to shout out is relevant to the most pressing matter at hand, which is most often stabilizing the patient -- for example, are their vitals crashing and everyone is focused on addressing that, or was the surgeon about to start operating on the wrong leg? If it were the latter scenario yeah any caring med student should bring up that they think the team got the leg wrong, but if the team was focused on something else, then whether the right or left leg is broken probably isn't the most vital information to clarify at the moment. It'd be something to circle back to when the patient is stable and things are less dire.

But later the resident who i asked to write my eval put “poor communication” and “talking over the attending” on my eval. Now the medical clerkship director who will eventually write my SLOE reviewed the eval told me i should work on my “professionalism”.

I think this is poor feedback. My guess is they had more of an issue with you yelling out not-so-pressing information at the wrong time and risked distracting resuscitation efforts more than the fact that you spoke over an attending. I would try to meet with the clerkship director to discuss that you learned from the situation and will improve.

 

[VincentAdultman]

Long thread warning

Hi I am a 4th year student in my EM rotation rn. I recently was in a trauma resus with a team of EM attending, residents and gen surg trauma team. During the resus the EM attending shouted to the scribing nurse that the right leg was broken. Because the right leg was in a splint somehow I didn’t notice it was broken. But I saw that the left leg of the patient was actually a little bit deformed so I shouted out that “no it’s the left leg”. Then the attending corrected me. I felt a little embarrassed that I didn’t see the real broken leg and corrected the attending in front of the whole team. But we are always told that if medical students see something wrong we should speak out about it, that’s why i did that during the resus. I know my tone was probably overconfident in a way, but I didn’t think it would be a big deal.

But later the resident who i asked to write my eval put “poor communication” and “talking over the attending” on my eval. Now the medical clerkship director who will eventually write my SLOE reviewed the eval told me i should work on my “professionalism”. It’s very disheartening. I know medical students should generally stay quiet during a trauma resus but I genuinely thought i was doing the right thing by speaking out, even though it turned out to be a wrong information. I didn’t know it would rub in the wrong way in the eyes of the resident.
I am just worried that now the clerkship director thinks I’m unprofessional, would it affect my SLOE? I just started this sub-i so i will have many more rotations. But I am worried i would have a negative comment on professionalism on my SLOE.

Sorry for my ranting and the long post. I honestly hate these EM evals so much…

Time and place. Which leg is broken doesn’t matter in that time. But Inget it. You thought you were doing the right thing. This is just the bullsht that comes with rotations. If it’s just a one-off thing though it should be easily explainable and not a big deal.

 

[EthylMethylMan]

I would try to meet with the clerkship director to discuss that you learned from the situation and will improve.

This is the thing to do ASAP. Agree with everyone else, good intention, bad timing. The more pressing matter is a bad SLOE. This kind of thing can ruin an EM application. Fortunately (if that’s even the right word), EM is a dumpster fire. You’ll probably match somewhere if you’re not a blatant danger to patients or a sociopath. But with a bad letter on your application, you may be stuck interviewing at HCA programs, which is its own unique hell. Try to get this ironed out. Beg if you have to.

 

[voxveritatisetlucis]

I don’t think it will hurt too bad, but even if it does, EM had like 500 infilled slots last year so I’m sure everything will work out

 

[EthylMethylMan]

I don’t think it will hurt too bad, but even if it does, EM had like 500 infilled slots last year so I’m sure everything will work out

An actively bad SLOE is a real detriment. In my experience, there’s an understanding that even below-average med students will at worst get a generic “student showed up and was pleasant” evaluation. Those are forgettable for programs. For an evaluator to go out of their way to leave negative remarks on an evaluation is unusual, and definitely leaves an impression.

 

[medDaisuki]

Thanks everyone i will email them and explain the situation. I dont think it would be too bad because the comment on my eval from the my previous EM subI was literally "polite, good team player, professional" etc lol

 

[EthylMethylMan]

Thanks everyone i will email them and explain the situation. I dont think it would be too bad because the comment on my eval from the my previous EM subI was literally "polite, good team player, professional" etc lol

That’s good, I’m glad to hear it. If you wind up in a position where that SLOE has to be on your app as-is, be prepared to discuss it. Talk about the good intentions you had, the fact that it was an honest mistake, the fact that you’ve talked to the people involved, and the fact that you understand the timing issue. Corroborating good SLOEs will back you up, and I think reasonable program faculty will be understanding.

 

[LucidSplash]

Thanks everyone i will email them and explain the situation. I dont think it would be too bad because the comment on my eval from the my previous EM subI was literally "polite, good team player, professional" etc lol

I think the advice above is NOT summed up as “you should explain the situation.” This risks coming across as being defensive and digging in your heels. You need to address that you realize that while your intent was good, you recognize this was wrong place, wrong time, wrong method of communication, and that’s what you learned, and even maybe suggest how differently you would handle a similar situation in the future. You should specifically NOT send an email to “explain the situation.”

 

[mrbreakfast]

Agree with everyone else.

You did the incorrect thing, even though your intent was good. Your job during emergencies is to observe. You are watching professionals work and need to consider that if you think something is being done incorrectly, it is by far more likely that you are incorrect. Feedback on this is appropriate.

I also agree that formal feedback on SLOE about "professionalism" and "poor communication" is poor feedback, and a meeting with the clerkship director (where you explain your mistake and what you learned) is appropriate. The goal of feedback is to be constructive and help you grow, and one (relatively small) mistake leading to this feedback is inappropriate.

I think there is a decent chance your evaluation may be changed. Best of luck.

 

[medDaisuki]

Yes

I think the advice above is NOT summed up as “you should explain the situation.” This risks coming across as being defensive and digging in your heels. You need to address that you realize that while your intent was good, you recognize this was wrong place, wrong time, wrong method of communication, and that’s what you learned, and even maybe suggest how differently you would handle a similar situation in the future. You should specifically NOT send an email to “explain the situation.”

yes thank you! I made sure I focused on I learned something rather than defending myself in the email. They gave a vague reply like oh I’m sure you will improve on this in the future. That eval was an end of shift eval, not the official SLOE, so I hope it won’t be a big issue if the other evals can back me up. Just felt that the comment “talking over the attending” was taken out of context.

 

[LucidSplash]

Yes


yes thank you! I made sure I focused on I learned something rather than defending myself in the email. They gave a vague reply like oh I’m sure you will improve on this in the future. That eval was an end of shift eval, not the official SLOE, so I hope it won’t be a big issue if the other evals can back me up. Just felt that the comment “talking over the attending” was taken out of context.

But it really wasn’t taken out of context? I think that’s the part you are missing. Attending was trying to communicate something to the team. You thought it was incorrect and decided to correct the attending unnecessarily. Even if you were right it was not the time or place to do so, it would not change patient care in the moment.

 

[SurfingDoctor]

As the adage goes.. "life over limb"

 

[medDaisuki]

But it really wasn’t taken out of context? I think that’s the part you are missing. Attending was trying to communicate something to the team. You thought it was incorrect and decided to correct the attending unnecessarily. Even if you were right it was not the time or place to do so, it would not change patient care in the moment.

Thanks everyone for the reassurance.

Yes it happened after we covered the ABCDEs already and the patient was going to get a CT foot. But I think I could have confirmed with the attending first before I shouted out to avoid causing confusion to the whole team. I think this really comes with experience.
Yes I agree during active primary survey on ABCs this would have been disruptive.

I’m going to move on from this and not stuck on one comment from one evaluator.