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MEdIC Series: The Case of the Overwhelmed Senior Resident – Expert Review and Curated Community Commentary


Our eighth case of season 5, The Case of the Overwhelmed Senior Resident, presented the scenario of a senior resident who felt overwhelmed when left to manage the department on a busy night shift while his attending physician was asleep in the back room. The resident debated whether to wake his attending to ask for help, but worried that it could be perceived as a sign of weakness or that he couldn’t “handle things” with autonomy. If you haven’t had a chance yet, we urge you to check out the case and share your thoughts on this important topic!

The MEdIC team (Drs. Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, Alkarim Velji, and Brent Thoma) hosted an online discussion around the case over the last 2 weeks with insights from the ALiEM community. We are proud to present to you the curated commentary and our expert reviews. Thank you to all participants for contributing to the rich discussions surrounding this case!

This follow-up post includes:

  • Responses from our solicited experts:
    • Dr. Gus Garmel is a Clinical Professor of EM, former Co-Director of the Stanford/Kaiser Residency Program and Clerkship Director for Stanford University School of Medicine. He is a passionate educator and mentor. He has authored 4 textbooks and published numerous articles and textbook chapters. He is a dedicated instructor for faculty, residents, medical students, and nurses. Dr. Garmel serves as a senior EP for TPMG, KP Santa Clara, a senior editor for The Permanente Journal, an invited reviewer for several EM journals, and chairs the Kaiser National EM Conference. He is active with ABEM, ACEP, AAEM, SAEM, CORD and EMRA.
    • Dr. Eric Nadel is an attending physician at the Massachusetts General Hospital Department of Emergency Medicine and is Associate Professor at Harvard Medical School. He is also the Program Director of the Brigham and Women’s/Massachusetts General Hospital Harvard Affiliated EM residency training program.
  • 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: Autonomy vs Safety: Striking a Balance (Dr. Gus M. Garmel)
Expert Response 2: Gaining Independence in an Era of Patient Safety/Quality Improvement (Dr. Eric Seth Nadel)
Curated from the Community (Dr. Sarah Luckett-Gatopoulos)

Case and Responses for Download

Click here (or on the picture below) to download the case and responses as a PDF (169 kb).


Tamara McColl, MD FRCPC

Tamara McColl, MD FRCPC

Associate Editor, ALiEM MEdIC Series
Emergency Physician, St. Boniface Hospital, WRHA
Academic Lead, Educational Scholarship
Department of Emergency Medicine
University of Manitoba