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MEdIC Series: Case of the Solo Senior – Expert Review and Curated Community Commentary


The Case of the Solo Senior outlined a scenario of an emergency attending who questioned the common consultant call-etiquette of not activating back-up call, whether that be another resident or the attending physician, on a busy call shift when the “solo senior” is obviously overwhelmed. This month, the MEdIC team (Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, Alkarim Velji, and Brent Thoma), hosted a discussion around this case with insights from the ALiEM community. We are proud to present to you the curated community commentary and our expert opinions. Thank-you to all participants for contributing to the very rich discussions surrounding this case!

This follow-up post includes

  • Responses from our solicited experts:
    • Dr. Lindsay Melvin (@LMelvinMD) is a General Internist at the University Health Network in Toronto, Canada. She recently completed her General Internal Medicine subspecialty training at the University of Toronto after finishing her core residency at McMaster University. Lindsay also recently completed her Masters of Health Professions Education at Maastricht University. Her academic interests include workplace-based learning, resident assessment and technology in learning.
    • Dr. Alim Pardhan (@AlimPardhan) is an Emergency Physician at the Hamilton Health Sciences and McMaster Children’s Hospital in Hamilton, Ontario. He is the Program Director of the McMaster University’s Royal College training program in Emergency Medicine and is the physician site lead for the Hamilton General Hospital Emergency Department. Alim graduated from the University of Manitoba Medical School and completed his residency in Emergency Medicine at McMaster. He subsequently completed an MBA at the Richard Ivey School of Business. His interests include medical education, physician leadership and hospital administration.
  • A summary of insights from the ALiEM community derived from the Twitter and blog discussions
  • Freely downloadable PDF versions of the case and expert responses for use in continuing medical education activities
Expert Response 1: A Complicated Interplay Between Autonomy, Supervision, Trust, and the Hidden Curriculum (Dr. Lindsay Melvin)
Expert Response 2: Prioritizing Patients First (Dr. Alim Pardhan)
Curated from the Community (Dr. Alkarim Velji)

Case and Responses for Download

Click here (or on the picture below) to download the case and responses as a PDF (299 kb).

Tamara McColl, MD FRCPC MEd(c)

Tamara McColl, MD FRCPC MEd(c)

Associate Editor, ALiEM MEdIC Series
Emergency Physician, St. Boniface Hospital, WRHA
Academic Lead, Educational Scholarship
Department of Emergency Medicine
University of Manitoba
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    Something that I think was missed in this discussion: especially for surgical services, our seniors and fellow residents are on home call for a week or more at a time. Still legal with ACGME rules, which only limit in-house call. On top of that, they are not protected- if they come in in the middle of night, they are still expected to be there the next day operating as normal. Every time a senior is called in, their fatigue level increases significantly. It is the same with our attendings- if they come in, that’s generally going to be at least an hour or two before they can get to bed again, and they must work and operate their full schedules the next day. The patients who will be operated on and taken care of by those senior residents and surgeons the next day must be a part of any discussion.

    If a few patients are seen a little later than ideal in the ED, that is unfortunate. If a critical consult- mesenteric ischemia, or limb ischemia- is delayed, that is of course unacceptable. For many other complaints however, protecting our senior residents and attendings from being called in to help with tasks which ultimately can be handled by junior residents, albeit in a delayed fashion, is an important goal that the ED should take into account before asking the junior resident to demand an attending or senior resident be brought in.