Resident is yelled at by a consultant
This is the original scenario, as submitted in the scenario generation phase. Click here to review and contribute to the realistic script, which is currently in development
Two physicians, resident and radiologist, meet in the radiologist's office. The resident requests an MRI for her patient.
The resident goes to request an MRI that her team (including her attending and a consulting service) feels is important for a patients care. The radiologist belittles her and suggests her request is absurd. The resident leaves in tears.
Category:
physician – learner/preceptor
What's happening?
Sep 12 2012 (All day)
Oct 13 2012 (All day)
Comments
Reasonable request and reasonable refusal
To detail this scenario, the residents request should be shown as reasonable. Perhaps she has direct experience whereby having the MRI made a significant difference. Likewise the radiologist should have good reason for declining the request.
In the two versions (skilled/unskilled) of the script, it can become clear that each benefits from learning the other's reasons for their position. Because of the initial scenario, I'd be inclined to have the resident prevail through good communiation skills and the radiologist acknowledge that an MRI is appropriate under the circumstances.
Responding to being yelled at / belittled
Learning how to appropriately respond to a superior (preceptor / consultant / senior resident) or colleague who is being mean is important and challenging for learners and junior faculty. A routine refusal isn`t as difficult for the residents to cope with as when they are yelled at / belittled.
The refusal is certainly realistic. Who is the protagonist?
I like the terms "realistic" and "empathic" when thinking about these scenarios. Based on a lot of experiences that have been related to me, the story that a resident would get yelled at, and would think that the radiologist was belittling her, is entirely realistic.
As in other scenarios, it depends on the choice of "protagonist". I'm using that term to mean the one person who is going to have their perspective translated in the second vignette. In all these scenarios, it would be wonderful if we could shoot three or four vignettes, as we did with Mike/Chris. But I'm not sure we have sufficient budget for that. In fact I'm pretty sure we don't. So we might have to leave that work for others to do if they get more funds.
In this scenario, we could choose either the radiologist or the resident as the protagonist. If we choose the resident, the empathic translation would involve the resident hearing the yelling and shouting and being able to guess what was going on for the radiologist. It might involve a bit of a request for a "time out" to settle herself. I'm not sure how plausible that situation is.
If we choose the radiologist as the protagonist, the empathic translation might be a bit more plausible. Instead of yelling in the second scenario, the radiologist guesses what the resident is noticing, feeling and needing, and confirms that before saying "no" in an empathic way, explaining what s/he is noticing / feeling / needing.
More realistic "realistic" scenario
I've commented in other scenarios that true "yelling" is actually not as common as feeling as if one's been yelled out. Perhaps, in the "realistic" the radiologist is unfriendly and cold (perceives him/herself as efficient) and doesn't give a good explanation for the refusal and then attempts to "teach" the learner by questioning (or "grilling" to the learner) him/her about the indications and characteristics of the test, making comments about what s/he should know by this level of training, for exams etc.
Could see either as the "protagonist"