Future Leaders Communiqué Volume 6 Issue 2 April 2021
Download PDF: FL Communiqué April 2021
Case: How do you know when you need to ask for help?
Expert Commentary: Be wise and confess to ignorance
Expert Commentary: Keeping an eye on junior doctors' clinical blind spots
Comments From Our Peers
This edition of the Future Leaders Communiqué is a reflection on the development of clinical experience. The case reviewed centres around a junior doctor’s assessment of a pregnant woman presenting to hospital with ‘rib pain’. The patient, Ms A, ultimately died of an undiagnosed pulmonary embolism. There were a number of red flags in Ms A’s presentation that may have assisted in making the diagnosis, and possibly averting the tragic outcome. One is led to wonder; if a more clinically experienced eye had been cast over Ms A, would the outcome of this case have been altered?
Clinical experience is achieved through exposure to a breadth of clinical scenarios, and a conscious effort to learn from them. Junior doctors are commonly faced with new or unfamiliar clinical scenarios. They have, by definition, limited prior experience to draw from. These scenarios can be particularly treacherous as gaps in experience are not always easily identified. The truism that “you don’t know what you don’t know” can be applied here. There is a difficult balance to be struck between trusting your training thus far and calling for more senior advice. How might a junior doctor recognise blind spots in their practice or gaps in their expertise? If you were faced with a similar dilemma to the case as described in this edition, how might you safely approach it?
Our guest editor for this edition, Dr Vincent Wong, has examined the finding of the coroner’s inquest into the case to offer us scrutiny and reflections on these questions. Dr Wong is currently a second-year Basic Physician Trainee at Alfred Health, Melbourne. He is passionate about clinical education as a way to pass on skills and experience, and to improve patient care. His clinical interests include nephrology as well as the study of human factors and system-based approaches to counteract bias and human error in clinical medicine.
Dr Wong has enlisted two highly regarded clinicians to shed further light on the issues raised by the case of Ms A. Dr Nhi Nguyen, an intensivist, offers his own reflections on the cultivation of clinical experience over the course of one’s career. Associate Professor Julia Harrison, an emergency physician and Director of Undergraduate Medical Education at the School of Clinical Sciences at Monash Health, offers her advice on common pitfalls in clinical assessment, and tips on how to pursue excellence in clinical assessment.
I am grateful to Dr Wong for collating a truly valuable resource for every junior doctor with this edition of the Future Leaders Communiqué. Our hope is that the ideas and reflections discussed resonate with you and that they play a small part in the evolution of your clinical experience.