OSCE Title

Putting junior doctor on a performance plan.

Author(s) Author Date Reviewer(s) Review Date

Laura Smith 31/3/15 Michelle Davison 31/3/2015

Station Type
History X Communication Practical Procedure
Examination Clinical Reasoning Crisis resource management
Comments/Other:

Domains

Select the domains that are applicable to this station

Medical Leadership and Scholarship and
40 Communication 40
Expertise Management Teaching
Prioritisation and Teamwork and 2
Health Advocacy Professionalism
Decision Making Collaboration 0
Domain Marking Allocation
Enter the mark allocations for this station for each applicable domain by double-clicking on
the pie chart below and completing the percentages.

Communication
Leadership & Management
Professionalism

Clinical Scenario Stem

Description
You are the supervisor of Registrar training in a training ED.
A senior nurse has come to you & made a formal complaint about one of your junior registrars. They
have detailed reports of three incidences in the last week where nurses have felt that the Registrar was
obstructive and rude. These included refusing to prescribe analgesia to an elderly lady with abdominal
pain “because she’s going to die anyway”, refusing to come and assist with IV cannulation after 2 failed
attempts by the nursing staff, stating “that’s not my problem, that’s a nurse job” and being challenged by
the nurse shift coordinator on why he had picked up a Cat 5 patient out of turn and saying “you can’t tell
me what to do, I’m a Registrar”. The nurse the heard them mutter “Bitch” as they walked away after the
incident.

Your tasks are to:

Clarify the details of the above instances with the Registrar.
Advise the Registrar of the plan for his ongoing performance management.
Instructions - Candidate

Candidate
.

Please use CTRL enter here for a page break and include any full page de-identified ECGs,
path results or imaging to be given to the candidate at this point.
Instructions – Role Player/Patient and Examiner

Role Player/Patient
You are a first year Registrar who is new to this department. You have been working as a surgical PHO
prior to commencing your ED training. You should maintain an arrogant demeanour. You think you are
very good at your job and find ED pretty easy compared to surgery.

You are new to the department, but have not been challenged in previous department on your
behaviour. “It hasn’t been an issue before this.”
You have no significant personal issues and do not use drugs or alcohol. You are not feeling the work
load to be too great.

You should initially be dismissive when your behavior is questioned. You should state they are “being
oversensitive.” You should state that all nurses should cannulate, it’s a basic skill and your time is more
valuable than being a “line monkey.”
If pushed, you will grudgingly acknowledge the feedback regarding your behavour and need for
professionalism.

You should prompt the candidate by asking what happens now if no discussion of a performance
management plan occurs.

Examiner
Observe only expect the candidate to act in an appropriate manner and follow good communication skills
Explore reasons behind behavior
Redirect behavior and suggest changes to be made.
Station Requirements

Equipment/ Props Personnel

Candidate and Registrar.

Marking Schedule - Global Criteria

Clear Borderline Borderline Clear Pass Excellent Comments
Fail Fail Pass

Opening

Interpersonal Skills

Information Gathering

Physical Examination

Practical Skills

Closing
Marking Schedule - Specific Criteria including any pass fail criteria

Domain Yes/ Detailed Assessment Criteria

No
Medical Expertise

Prioritisation and
Decision Making
Communication Allows registrar the opportunity to state their case & actively listens.
Makes a clear expression of unacceptability of behavior and outlines
acceptable standard of professionalism required of the Registrar.
Communicates a clear plan to performance manage the Registrar and the
expected outcomes. Outlines consequences for non-compliance.
Teamwork and
Collaboration
Leadership and Explore personal / social / clinical knowledge / work stress/ health factors
Management that may be playing a part.
Be absolutely clear that behaviour is unacceptable & why.
Suggest ways that the Registrar might be able manage situations
differently.
Outline performance plan.
Explain consequences of persistant behavioural issues.
Health Advocacy

Scholarship and
Teaching
Professionalism Maintains a professional demeanour throughout difficult interaction with
Registrar.
Avoids judgemental approach to the Registrar.

OSCE Station Difficulty

Low Difficulty Moderate Difficulty High Difficulty*

Comments:

Overall Mark
Pass Fail
Comments: