The Case of the Unexpected Outcome presented an attending trying to deal with a poor outcome in one of their patients despite competent medical management. No matter how good of a clinician we are, odds are that at some point this will happen to all of us. In addition to being potentially emotionally devastating, a serious miss can make us question our competence and shift our practice patterns from evidence- to anecdote-based. Check out the ALiEM community’s discussion of the case.
Emergency medicine is a specialty that requires a level of comfort with uncertainty. No matter how good of a clinician you are, at the end of the day there will be patients that, despite solid medical care, will have an unexpected outcome. In addition to being potentially emotionally devastating, a serious miss can make us question our competence and shift our practice patterns from evidence- to anecdote-based. Dealing with these issues productively will be the topic of discussion in this months MEdIC.
We are very excited this month to bring you our third Global Journal Club. We hope you will participate in an online discussion based on the clinical vignette and questions below from now until March 27th. Respond by commenting below or tweeting (#ALiEMJC).
On Tuesday, March 25, 2014 at 1630 EST, we will be hosting a 30-minute live Google Hangout with Dr. Niklas Nielsen, the lead author of the Targeted Temperature Management (TTM) study, that is informed by the discussion. Later this year a summary of this journal club will be published in Annals of Emergency Medicine.
Why do we do what we do?
This is the question at the heart of this month’s ALiEM Book Club selection. Drive 1 , by author Daniel Pink, discusses the history of motivational theory before provocatively making the case that we’re doing it wrong. He argues that having met our base desires (food, drink, sex), a reliance on extrinsic motivators (reward and punishment) will stifle intrinsic motivation and prevent us from functioning at our highest capacity. The three features described for optimizing intrinsic motivation are:
- Autonomy: control over task (what we do), time (when we do it), team (who we do it with), and technique (how we do it)
- Mastery: the desire to get better at what we do using a mindset of improvement and working through challenges of appropriate difficulty
- Purpose: being part of a cause that is greater and more enduring than ourselves
It was a few months into my simulation fellowship and I had been devoting a lot of my time to teaching at the medical school. I loved it. I find few things as fun as teaching students who are super motivated to learn. That got me thinking about why learning isn’t always that way. What is it about certain settings that foster a student’s passion to learn while others, that may be presenting the exact same content, cause the same group of students to grumble and disengage?
The Case of the Terrible Teammate presented a conflict between a team of chief residents. Sarah got upset because David seemed to be shirking his responsibilities and getting her to do all of the work. While we provided a specific context for the case, interpersonal disagreements over the distribution of work may come up in any work arrangement that splits responsibility between two or more parties. When it does, how should we deal with it? This month Dr. Teresa Chan (@TChanMD) and I (@Brent_Thoma) explored this issue with insights from the ALiEM community and 3 experts.
None of us would be where we are today, if it weren’t for the people that have helped us along the way. During this holiday season we thought it would be appropriate to discuss a happy topic: how to thank your mentors. The fine people who have taught and guided us over the years – helping us become the physicians we have become. This month in the MEdIC series, we present the case of Kara and Sundeep, two residents who are not sure how to go about thanking their mentors.