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Paeds Vivasprofessional-practice-and-evidence

Paeds Vivas · professional-practice-and-evidence

Clinician wellbeing, fatigue and sustainable practice — branching viva

Viva on the Maslach burnout framework, the demands-resources mechanism, the fatigue-to-error cascade, the second-victim phenomenon, and the layered individual, team and organisational response.

branching clinical structured oral3 min readVerification in progress

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
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Study tools

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Paediatric ward night shift: a registrar near the end of a long shift almost gives a tenfold opioid dose to a young child; a nurse intercepts it; the registrar is exhausted, becomes tearful and says she has been sleeping poorly for weeks and feels she is bad at her job; the baby is unharmed; the consultant is on the end of a phone.

Opening (candidate)

My first priority is the patient: the error was intercepted and the child is unharmed, so I would confirm the child is safe and the dose never reached them, and reassure the nurse who acted well. Then I would look after the registrar. She is acutely impaired by fatigue and showing a second-victim response, so I would relieve her from further high-risk tasks, ensure she is supported and not alone, and speak with her privately once the clinical situation is stable. I would also report the near miss, because it is a systems signal, not only a personal one. [1] [5]

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You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship library.

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References6ShowHide
  1. [1]Landrigan CP Effect of reducing interns' work hours on serious medical errors in intensive care units N Engl J Med, 2004.PMID 15509817
  2. [2]Philibert I Sleep loss and performance in residents and nonphysicians: a meta-analytic examination Sleep, 2005.PMID 16335329
  3. [3]West CP Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis Lancet, 2016.PMID 27692469
  4. [4]Panagioti M Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis JAMA Intern Med, 2018.PMID 30193239
  5. [5]Wu AW Medical error: the second victim. The doctor who makes the mistake needs help too BMJ, 2000.PMID 10720336
  6. [6]Scott SD The natural history of recovery for the healthcare provider second victim after adverse patient events Qual Saf Health Care, 2009.PMID 19812092
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