Transcript for START 4 - Feedback

[Kaylan] So how did that go then, Olivia?

[Olivia] Well, I think some parts of it were good, and some parts of it were less good.

[Ka] That'll happen to even the best performer. So there are loads of positives in what you did. We look at the negatives, there are very few. We can look at it later.  So, what do you think went well?

[O] So things that I think went well is I think I did a good systematic assessment.

[Ka] Yeah, you did.

[O] And I feel that I tackled A through E quite well, so it went through the airway.

[Ka] Yeah, you went through the whole lot very well. And this patient was very sick, and you did all the right things. And did the right way, and came to the right conclusion. And you did really well I think.

[O] Well, thank you.

[Ka] Okay, so any other sort of positive sort of--

[O] Things that I did well. Well, I suppose one thing that I think went well is that I came to a diagnosis.

[Ka] You did.

[O] Which I think was the right diagnosis. And then following that, came through with some form of management plan.

[Ka] Absolutely, and you came to the right conclusion using the algorithm.

[O] Yeah, helpful actually.

[Ka] So whenever you are stuck, you go back to the algorithm and you can get the right diagnosis. Anything else, Kim?

[K] Yeah, so I just made a couple of notes. So I thought you did a really good full patient assessment. You had a really good systematic approach from A to E. You got a little bit stuck when you got beyond that, but you referred back to the algorithm. You knew exactly what to do next, and you carried on.  And as Kalyan said, you then got the diagnosis and a management plan. 

What you need to remember is that, as Kalyan said, you had a really sick patient here that yes, you quite rightly said was unstable. But you got the patient to the point where they were safe enough to be handed over to Med Reg  to then do the next thing, which is the endoscopy and escalation. So you achieved all of that, so that's really good.

[O] Thank you.

[Ka] Yeah, the interpretation of the results, the verbalizing it, fantastic.

[O] Thank you. 

[Ka] Fantastic. There will always be some negatives, but there are very few. You can always work on it, okay? So is there anything you could've done better you think?

[O] Yes, I thought that I didn't manage the airway very well initially. I think I--

[Ka] Yeah, it didn't do any damage--

[O] Yeah, I jumped into the Guedel.

[Ka] But yeah, you can do it with the basic stuff, airway management. Anything else?

[O] Well, other than that I think my communication with the Medical Registrar didn't go quite the way I thought it was going to go. I think it wasn't as slick as I hoped it would be,  having done--

[Ka] Do you follow any format for handover?

[O] I was trying to do the SBAR. At least I thought I was doing the SBAR, but at the end it seemed a bit like I'd said quite a lot and it wasn't going--

[Ka] What are you thinking?

[K] Again what I've written down here is that I thought you did a really comprehensive handover, there wasn't anything that you missed out. It's just in that sort of scenario  you want a really quick, slick effective way. So using the SBAR is right. But in that scenario you talked a lot about the blood results  and there was lots of information there, but really what the Med Reg is wanting is kind of the headline.

The situation is you've got a 54 year old man having a variceal bleed. The background is he's got alcoholic liver disease. And he's bleeding. 

[Ka] And he's bleeding,

[K] and you need an endoscopy.

[O] Yeah, I want a scope.

[K] And you want him escalating. And so there's kinda four lines there, and the Med Reg can go in and go, "Right, I know exactly what I need to do."

[O] Yeah, exactly. Okay, yeah.

[Ka] So you don't miss anything and you communicate well in this way, exactly the salient point.

[K] And the important thing to remember is that will come with time. We're not expecting foundation doctors to just do the perfect SBAR straight away.  It's things that we all still practice now and still get wrong ourselves.

[O] Yeah, absolutely.

[Ka] And so overall, very good performance. There are lots of positives to take home.

[O] Okay, thank you. 

[K] Okay? Well done.

[O] Thanks a lot.