Seth MacfarlaneWelcome to season 3, episode 3 of the ALiEM Medical Education in Cases (MEdIC) series! Our team (Brent Thoma, Sarah Luckett-Gatopoulos, Tamara McColl, Eve Purdy, and Teresa Chan) is pleased to welcome you to our online community of practice where we discuss difficult medical education cases each month. As usual, the community discussion will be reviewed using qualitative research methods to produce a curated summary that will be combined with two expert responses to create a functional teaching resource.

This month’s case features a problem that educators face when interacting with off-service residents. What is the role of an attending on one service when dealing with residents providing care from another discipline? Does it take a whole village to raise a resident? Please read the case and join in the discussion below!

[su_spoiler title=”MEdIC Series: The Concept” style=”fancy” icon=”caret”]Inspired by the Harvard Business Review Cases and initially led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@Brent_Thoma), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the fourth Friday of the month, we pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses are be made available for download in PDF format – feel free to use them! If you’re a medical educator with a pedagogical problem, we want to get you a MEdIC. Send us your most difficult dilemmas (guidelines) and help the rest of us bring our teaching to the next level.[/su_spoiler]

MEdIC: The Case of the Cackling Consulting Resident

by Drs. Teresa Chan (@TChanMD) and S. Luckett-Gatopoulos (@SLuckettG)

It was a long, busy night in the ED. Ellen was tired. The department was nearly bursting at the seams, and dispatch had called to notify her that another multisystem trauma was on the way.  As the only overnight attending, she had been constantly running throughout the shift.  She had just spent a half hour trying to find somewhere to discharge Mrs. Patterson, a mostly-well 83-year-old lady with early dementia. Mrs. Patterson had been dropped off at the hospital with a “positive suitcase sign” per the triage note and worsening urinary incontinence. Despite homecare, Mrs. Patterson’s family just could not provide the level of support that she needed to live at home anymore. Unfortunately, they were nowhere to be found when her workup came back normal. The nurses had heard them discussing their flights to Mexico.



“Everything okay?” asked Ravinder, after witnessing some significant handset-on-phone violence.

Ellen had just slammed down the phone when her colleague Ravinder had walked by and was stopped in his tracks by the look of shock and frustration on her face. She had called the medicine service to request a social admission for Mrs. Patterson.

“No!” she replied emphatically.  “But maybe I’m just tired or something. Can I run this case by you?”


Ellen recounted the nuances of the case back to Ravinder, describing the various red flags for elder abuse, and how Mrs. Patterson’s family had clearly just dropped and run.

“Sounds reasonable to me,’ Ravinder agreed with Ellen’s plan. ‘I mean, what else can you do? She needs an admission.  Sure, it’s mainly for social reasons, but still…”

“I know! But I told the resident on call and she laughed at me! I couldn’t even tell her the story because she kept interrupting with laughter. She said there was no way that I should even think about admitting her. I’ve been doing this for nearly a decade and never has anyone been so rude.”

Discussion Questions

  1. As her colleague, what advice would you give Ellen?
  2. Where should she go from here?
  3. How should she respond to the resident? What is your role as an attending from a different discipline?

Weekly Wrap Up

As always, we will post the expert responses and a curated commentary derived from the community responses one week after the case was published. This time the two experts are:

  • Megan Boysen Osborn, associate residency director in the Department of Emergency Medicine and co-course director for Clinical Foundations at UC Irvine
  • Dara Kass, Assistant Professor, Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine

On Dec 11, 2015 we will post the Expert Responses and Curated Community Commentary for the Case of the Cackling Consulting Resident.  After that date, you may continue to comment below, but your commentary will no longer be integrated into the curated commentary.  That said, we’d love to hear from you, so please comment below!

All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental. Also, as always, we will generate a curated community commentary based on your participation below and on Twitter. We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.

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Eve Purdy, BHSc MD

Eve Purdy, BHSc MD

Queen's University in Kingston, Ontario, Canada
Student editor at
Founder of