Table 2 Example patient outcomes in cases of resident uncertainty in decision making
DomainMajor category/sub-themeRepresentative comment and patient presenting chief complaintRepresentative patient outcome
Conceptual uncertaintyEscalation of careCC: Patient with potassium of 7.3: “it was a lesson …, some of the stuff I mean if I am worried about it I think I get caught up in like I don’t want to bother the renal fellow and they said [the patient] doesn’t need dialysis and even if I think she does, I am the lowly resident so that was one where …, I should have just like bit the bullet and called because it sounds like they actually had the [wrong] information … everything was fine, she didn’t like die or … but I think she would have benefited from dialysing earlier and I would have gotten some sleep” [R#11]Patient did not require escalation of care; patient did not have an adverse event
Technical uncertaintyProcedural skillCC: Patient with HIV/AIDS, fever, and mental status changes “the standard work up included an LP and I felt like I couldn’t get, I am not trained on how to do them and I just felt like let’s do this tomorrow …”[R#12]Patient treated empirically with meningitis-appropriate doses of antibiotics*
Personal uncertaintyGoals of careCC: Patient with severe chronic obstructive pulmonary disease transferred from medical intensive care unit to general medicine service “I discussed with a lot, with this particular patient’s outpatient attending and the decision was made pretty quickly to make him comfort care and he actually died that day and I never actually talked with my [ward] attending about that patient until I talked with her later in the night and said that he had passed away and then the next day it was obvious that we had missed something on the chest x ray”[R#8]Patient given comfort care after family discussion and died, secondary to an unrecognised procedural complication
  • *Of the four patients in whom residents expressed procedural anxiety, none received the procedure in question.