Are you ready??website cpr image 2 Season 2 of the ALiEM MEdIC series is about to begin! We are so excited to kick off the ‘school year’ with a riveting new case from our Medical Education in Cases series.

Join us now to discuss the case of the Backroom Blunder wherein Trevor, the 3rd year medical student, finds himself reflecting about the use of humor by his colleagues in the resuscitation bay.

MEdIC Series: The Concept

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.

The Case of the Backroom Blunder

by Heather Murray (@HeatherM211)

Trevor, the 3rd year medical student rotating in the Emergency Department, sat down in the staff changing room to gather his thoughts. He had never seen a cardiac arrest before, and this one had been a doozy. An elderly, obese man had come in by EMS after suffering cardiac arrest from a huge lower GI bleed. The ED team had run the arrest for a really long time, transfusing blood, IV fluids and tons of drugs, intubating, bedside ultrasound, everything. The room had been a mess when they finally called it. Trevor had gone with Dr. Elliott, the attending, to break the news to the family. He had been impressed with her gentle compassion as she talked with them.

Trevor was thinking about the code. He was pretty pleased with his CPR – he’d practiced in the sim lab to get the timing and compression depth just right. Dr. Elliott had even complimented him on it. He thought about the smell – melena, rectal bleeding, vomit… it had been really awful. He hoped they could make the room smell better before the family came in. They had been so upset. He thought about the rest of the code. It seemed like Jeff, the senior resident, had struggled with the intubation. There had been quite a scene at the head of the bed. Jeff had needed 3 extra suction catheters to deal with all the airway vomit. Dr. Elliott had even asked if Jeff wanted her to take over. Trevor thought that it should have been a bit smoother.

He got up and left the change room. As he was about to come around the corner, he overhead Dr. Elliott and Jeff talking. He stopped, not wanting to interrupt, but as he listened he realized they were laughing together about the code! He heard them making jokes about the smell and the rectal bleeding, calling the patient a “frequent flyer” and talking about his “red underpants.” They didn’t seem to care at all that he had died, or about how awful it had been. And Jeff had screwed up the airway, Trevor was sure of it. Shouldn’t he be apologizing to Dr. Elliott instead of laughing? Dr. Elliott had seemed so nice and sympathetic to the family… was that all pretend? A fake show of sympathy?! Now Trevor was angry.

After Dr. Elliott and Jeff went back into the ED, Trevor stayed in the back hall, fuming. Sonia, another 3rd year student, arrived for her shift. When Trevor told her about Dr. Elliott and Jeff’s conversation, she pursed her lips and thought for a minute.

“Weird. Dr. Elliott always seems like she cares about people to me. Maybe it upset them, too? Maybe they’re just blowing off steam?”

“No way. A caring doctor would never talk like that. And the slang? That’s just awful. That man was somebody’s dad, and grandpa. I’m thinking of writing a complaint.”

Key Questions

  1. Medicine has a lot of slang – words that are specific to our particular culture, and sometimes derogatory. Is there a role for this language? Should medical educators be held to a higher standard?
  2. Black humour has been used as a coping strategy for stressful or traumatic events. Is this appropriate in a patient-centered care world?
  3. How should physicians cope with stressful or horrifying situations? How can we “blow off steam” effectively, and how can we support our learners?


Weekly Wrap Up

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

  • Dr. Brian Goldman (@NightShiftMD) is a staff ED physician at Mount Sinai Hospital and host of White Coat, Black Art on CBC Radio One.  His new book The Secret Language of Doctors is about hospital slang and what the slang reveals about modern medical culture.
  • Liz Crowe (@LizCrowe2) is an Advanced Clinician Social Worker in the Pediatric Intensive Care Unit at the Mater Children’s Hospital, Brisbane Australia. She also is involved in a large research project on Advance Care Planning with Griffith University. She is doing a doctorate examining staff wellbeing in critical care to inform interventions of support and education. Liz is a passionate and humorous educator and the successful author of ‘The Little Book of Loss and Grief You Can Read While You Cry’. When Liz is not working, studying, or writing, she hangs out with her kids and husband and enjoys walking, cycling, and reading.

On October 3, 2014 we posted the Expert Responses and Curated Community Commentary for the Case of the Backroom Blunder.  After that date, you may continue to comment below, but your commentary will no longer be integrated into the curated commentary which was released on October 3, 2014.  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.

Teresa Chan, MD, MHPE
ALiEM Associate Editor
Emergency Physician, Hamilton
Associate Professor, McMaster University
Assistant Dean, Program for Faculty Development, McMaster University Ontario, Canada
Teresa Chan, MD, MHPE


ERDoc. #meded #FOAMed Own views expressed. Contributor to @ALiEMteam, @WeAreCanadiEM, ICE Blog, #FeminEM. @MedEdLIFE founder. Works @McMasterU & @HamHealthSci