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HOW CAN I AVOID SCIs
There are ways of working that can help to minimise the risk of becoming involved in SCIs. All healthcare practitioners can develop useful skills and habits that can sustain them throughout long successful careers regardless of seniority or specialty.
Advice from and to other doctors includes (CLICK THE TABS BELOW):
This relates to Dupont’s Human Factors: Lack of Knowledge and Lack of Awareness
Trainees have found that it can be helpful to develop a support multi-source network - a mixture of people, online sources and texts and be clear about the role each of them is qualified to play.Some people might be able to offer sound advice and guidance e.g. educational supervisors and training programme managers; others, e.g. partners, peers, housemates, family may play an important role by providing you with a sounding board to help you reflect on a challenging situation and consider ways of approaching it.
Health Education England offers the Professional Support Unit which is a free service dedicated to supporting the progression of postgraduate training for trainees. It operates independently of specialty schools; training programmes or Trusts and offers a range of confidential and impartial support or advice for those who need it.
Medicine’s professional, representative and statutory bodies e.g. the GMC, the BMA and the medical defence organisations and the Royal Colleges all offer support to doctors. The GMC has a medico-legal team which is available 8am-6pm Monday to Friday and provide an on-call service for medico-legal emergencies or urgent queries, 24-hours a day, 365 days a year.
Medical defence organisations a 24-hour helpline to their members staffed by a doctor who can offer immediate advice and support. There is more information in Section 6.
Never leave work being worried about an experience – always talk to someone before you go home if you are worried about anything. The key priority is to be open if you think you have been involved in an SCI or have witnessed one.
Action Point 5:
If you were suddenly involved with an SCI, who would your top 4 'go to' people / places be?
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What could you gain from your conversation with them? |
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This relates to DuPont’s Human Factors: Lack of Knowledge and Lack of Assertiveness.
The GMC says that all doctors must work within the limits of their competence (GMC 2013)
Medical training can be very lumpy in terms of what you have had the opportunity to experience and practise. This has been exacerbated by 2020 Covid-19. The GMC has found that more than 8 out of 10 trainees have had their training affected by the pandemic https://www.gmc-uk.org/news/news-archive/covid-disruption-hits-training-for-eight-in-ten-doctors-gmc-surveys-shows.
In addition, your level of confidence may well fluctuate from setting to setting, from rota to rota. Know what you are competent and safe to do, assess your knowledge and skills regularly and ask questions rather than make assumptions. Get into the habit of seeking feedback on your practise and ask for support from senior clinical colleagues when required. Talk to your educational supervisor and peer group to keep your perceptions proportionate.
For example, you may have felt competent to take blood gases on your last placement (or indeed in a different country, if you trained overseas). However, in your next placement, possibly in a new Trust they might use different equipment or have a different blood gas analyser. You will need to build your knowledge and skills to become competent again with new kit. Nurses are often a good source of advice, support, and information in these situations. Being honest and showing some humility by asking for help or double-checking are strengths and demonstrate that you know the limits of your competence.
This relates to Dupont’s Human Factors: Assertiveness and Lack of Resources
It is very easy in pressurised environments to feel rushed. Learn what you can from shadowing colleagues and ask lots of questions about how they work out what they do first when busy. Watch how others operate in a busy environment and identify what you can learn from observation.
It is easy to get sucked into by an environment in healthcare but standing back, giving yourself a minute to think ‘Is this normal? Is this right? Do I need to say something?’ can save lives. There is an excellent YouTube video called Just a Routine operation which demonstrates how a doctor pausing may have saved a life in a real life situation:
This resource might be useful to help you slow down by developing some new behaviours:
- Mind tools: Beating hurry sickness https://www.mindtools.com/pages/article/how-to-beat-hurry-sickness.htm
This relates to Dupont’s Human Factors: Lack of Assertiveness and Pressure
Assertiveness means expressing your point of view in a way that is clear and direct, while still respecting the views of others. It is a skill that all doctors are encouraged to demonstrate but can be difficult to develop in pressurised working environments. In an interesting article for the BMJ, as a trainee you are advised to speak clearly about how you feel about a scenario e.g:
- I am not sure why we are doing it this way
- This situation is making me feel uncomfortable and concerned
- I am new here; can you explain why we are doing this?
Encourage others to speak about how they feel. If you are particularly concerned about an issue, make sure there is a paper trail to demonstrate what you have done or said (BMJ 2017). If you would like to develop your assertiveness, do approach HEE, it offers trainees several online resources as well as personal coaching.
This relates to Dupont’s Human Factor: Lack of Knowledge and Lack of Awareness
Prioritisation is about identifying what it is that is most important/urgent to do is an essential skill worth developing and refining. Talk to your peers, nursing colleagues and senior colleagues about how they prioritise the work to be done and their rationale for setting priorities e.g. see the sickest patient first. The Royal College of Physicians of England (2017) and the Royal College of Physicians of Edinburgh (2017) have both published guidance for junior doctors on how to prioritise. See Helpful Resources list in Section 11.
Action Point 6
Scenario: you are working on a very busy surgical ward. The staff nurse presents you with a new patient’s drug chart and asks you to prescribe a drug that you have not come across before. You are conflicted - you are new, you want to get on with the nursing staff and develop a harmonious working life with the MDT, but you have deep reservations:
| What do you feel? | What will you say? | What will you do? |
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Now read the guidance below from the GMC (Good practice in prescribing and managing medicines and devices (GMC 2013) – might you change your answers and actions?
14. You should prescribe medicines only if you have adequate knowledge of the patient’s health and you are satisfied that they serve the patient’s needs
16. In providing clinical care you must: prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health, and are satisfied that the drugs or treatment serve the patient’s needs.
37. If you prescribe at the recommendation of another doctor, nurse, or other healthcare professional, you must satisfy yourself that the prescription is needed, appropriate for the patient and within the limits of your competence.
This relates to Dupont’s Human Factor: Lack of Knowledge
Checking key reference material can be reassuring. Several helpful apps and texts are available online e.g. BNF which offers easy access to the latest up-to-date prescribing information from the most widely used medicines information resources, within the NHS. In addition, there are apps to offer overviews of clinical skills and algorithms. MD Calc which has various scoring systems and algorithms that you use throughout your career e.g. creatinine clearance, Wells’ criteria and many more.
The Mid-Yorkshire Trust has compiled a useful list of such resources and there are many more online (do check the validity of your online resources). https://www.midyorks.nhs.uk/download/doc/docm93jijm4n6198.pdf?amp;ver=7619
This relates to Dupont’s Human Factor: Lack of Teamwork
An important feature of working as a junior doctor is that you are always part of a team. Experienced junior doctors advise new doctors to ask lots of questions and check with colleagues when you are not sure. In addition, develop harmonious relationships with other members of the multidisciplinary team especially the nursing staff who are frequently permanent features of the ward/ clinic/ team and knowledgeable.
This relates to Dupont’s Human Factors: Fatigue and Stress
Medic Footprints offers tips for newly qualified doctors which include getting to know the staff you work with, taking all of your annual leave and making sure you take good care of yourself- eating well, staying hydrated and getting enough sleep. https://medicfootprints.org/the-fy1-doctor-survival-guide-top-tips-for-new-junior-doctors/.
If you are feeling particularly tired or unwell, talking to an experienced colleague may be helpful; your sense of duty may mean that you need a colleague to tell you to take some time out.
The BMA has a range of resources to support medical wellbeing, whether you are concerned about yourself or the health of a colleague. https://www.bma.org.uk/advice-and-support/your-wellbeing
It is good to remember that in the GMC Good Medical Practice you have an obligation to report concerns you may have about any colleagues:
- 25c If you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from colleague, your defence body, or the GMC. If you are still concerned you must report this, in line with our guidance and your workplace policy, and make a record of the steps you have taken.