Illustrative Cases

Illustrative cases (PGME)
These cases are intended to start conversations about professionalism in the workplace, classroom, or clinical space. They are examples of situations that many of us may find ourselves in, or identify with, in some way. They can be used as stems for educational conversations about professionalism, in one-on-one sessions or group settings. The goal is not to find the 'perfect solution', but rather, to be aware of the nuances at play, and to become aware of each person's perspective, in order to make the best decision, for that moment in time. The CanMEDS framework and definitions for the Professional role may serve as an excellent reference tool, when having these conversations.

1A. Commitment to Patients: Student

"I was so freaked out by this case. I just want to talk to someone about it..."

It is a "quiet" mid-morning in the ENT clinics. The staff-person decides to take the team (including the keen elective medical student) to the hospital Starbucks for coffee.
While standing in the usual 20-person deep line, the medical student tells your team about the drunk, unconscious sexually assaulted teenager that was found at the carnival, last night. He was involved in her difficult airway management while on call.

Guiding Questions:
How is the confidentiality of the patients threatened?
What sort of support can peers provide in this situation?
How do time and place affect the appropriateness of this student's storytelling?
What is the role of storytelling in gaining social support in the workplace?
How could the student cope with this terrible story in a more professional manner?

1B. Commitment to the Patients: Faculty

"I am so tired. And she needs the money...."

A young female physician is overwhelmed by the demands of clinical work, research, home and family. During a routine clinic visit, her patient's mother (who she knows well) tells her that she is looking for work as a housekeeper. The young doctor thanks her lucky stars, and makes arrangements to hire the parent.

Guiding Questions:
Discuss any conflicts of interest in this scenario.
How might this arrangement affect the dentist's relationship with his patient?
Does the size of the community they live in affect your perspective? How?

2A. Commitment to Society: (Student)

"I saved him a trip to the emergency department…"

It is Saturday night, and you finally have the weekend off from the emergency medicine rotation that you are currently assigned to. After a night of partying, you, as the designated driver, are taking people home. One of your friends, a fellow medical student, is very drunk, and has been vomiting. He needs fluids and rest. He can't keep anything down, and you suggest a trip to the emergency. He begs you not to take him, because he is worried that the clinical staff will judge him when he returns to work on Monday. Your friend asks if you would start an IV on him, and give him some fluids, at home.

Guiding Questions:
Describe any conflicts/issues that might arise from treating a colleague/friend?
Describe any conflicts/issues that might arise from treating someone outside of your professional setting/hospital?
Is it 'okay' to take medical supplies from the hospital, IF it spares 'the system' the cost of a medical visit?

2B. Commitment to Society: (Faculty)

"But if she can't work, it is bad for her patients…"

You are a radiologist. Your good friend, an orthopedic surgeon, has had progressive, increasing weakness and limited range of motion in her dominant arm, and extreme neck stiffness. She is struggling to move comfortably, and it is slowing down her clinical pace. She has seen her family doctor, and an MRI has been booked, with a date in 2.5 months. Over dinner, your friend mentions her struggles and progressing symptoms, in passing. You think "Maybe I can get her MRI bumped up…after all, she IS getting worse".

Guiding Questions:
Is it 'alright' to bump up someone's appointment, like this? What circumstances might make it okay? Is it never okay?
What might be the impact on others (eg patients, other office staff, yourself) of such an action?
Do you have any strategies for managing/addressing the expectations of family and friends?

3A. Commitment to the Profession: Student

"Wow. That was so inappropriate. What do I say?"

It is the end of yet another LONG teaching session! As is often the case, medical student Jaime has left 30 minutes early…leaving you feeling a little envious! As the remaining attendees exit, you, the preceptor, and the divisional administrative assistant are left in the room.
Your preceptor launches into a 5 minute rant, directed at you, about how inappropriate medical student Jaime' behaviour is, and how unprofessionals it is that he routinely arrives late and leaves early. He then turns to the admin assistant and says "Isn't that BS? I mean, seriously, we all have to show up."

Guiding Questions:
What questions might you want to ask Jaime?
How might you express your discomfort to the preceptor? Would you express it, at all?

3B. Commitment to Profession: Faculty

"I have so much to do. if I don't delegate, I'll never get through it."

An extremely busy staff surgeon asks a medical student to obtain consent for a patient's tonsillectomy. The student has never seen or performed this procedure before.
The surgeon explains the 'gist of it', and then tells the student to quickly go and get the papers signed so that they can 'get it off their list of things to do', and then heads down to the ED for the pending seven consultations.

Guiding Questions:
Have you been in a situation like this before? How did you respond then?
What are the risks to you, the patient, the clinical instructor, the hospital? What are the benefits for the same people?

4A. Commitment to Self: Student

"I really want to stay and support my scared patient, but my family misses me...."

You are working in the NICU, covering labour and delivery. You have closely followed a lovely pregnant lady who has been admitted for weeks with threatened premature labour. This is a very precious baby for her, having lost two previous infants in childbirth. For a number of personal and professional reasons, you have developed a real sense of caring and concern for this lady.
She was induced early in the morning, and it is now 5pm. She is getting closer to active labour, but not there, as yet. She begs you to stay for the delivery, she is in tears, and says she trusts only you to care for her newborn.
You have promised your boyfriend that you will attend his soccer game tonight, as he feels he 'never' gets to see since you since you started clinical clerkship.

Guiding Questions:
How would you want to respond in this situation?
What do you consider healthy professional boundaries?
What might the impact be to the patient if you choose not stay late?
What is your opinion on the value of work-life harmony? How do you achieve it?

4B. Commitment to Self: Faculty

"It's just dinner. What's the big deal?"

You are a newly minted staff-person, and have recently moved to Edmonton. At the end of a long OR day, followed by 2 emergency cases, you are finally ready to leave. Your senior resident has worked admirably alongside you, and is equally exhausted.
You want to acknowledge this individual's work and you are hungry! You text them and invite them to dinner…your treat.

Guiding Questions:
What considerations are there for determining if this is an appropriate social encounter?
How important do you perceive professional reputation to be?
How could this situation be perceived from an outside view?