Supporting a fatigued colleague after a near miss — OSCE

Station brief (8–10 minutes)

A registrar on a night shift almost gave a tenfold opioid dose to a young child. The nurse intercepted it and the child is unharmed. You are the consultant. The registrar is exhausted — she has slept poorly for weeks — tearful, and says she feels she is "bad at her job." Confirm patient safety, support the trainee, and describe the system response that would make this service sustainable. Do not invent local statutory wording or practitioner-health contact names you do not know. [1] [3]

Tasks for the candidate

1. Confirm the child is safe and the near miss did not reach them, and recognise the nurse's good catch. [1]
2. Relieve the trainee from further high-risk tasks and ensure she is supported and not alone. [3]
3. Offer structured second-victim support — peer support, a blame-free debrief, and signposting to practitioner-health services. [4]
4. Screen directly for distress and suicidal ideation; ask whether she is safe. [3]
5. Describe the organisational response — roster change, workload, team support, leadership ownership — framing burnout as a systems problem. [2]

Expected performance

Must hit. Confirms the child is safe and the dose never reached them before anything else; thanks the nurse for the interception; relieves the trainee from further safety-critical tasks and ensures she is not alone; offers a blame-free debrief and peer support; asks directly whether she is safe and about suicidal ideation; frames the event as a system failure driven by fatigue and burnout, not personal incompetence; names a concrete system response such as roster change and leadership ownership. [1] [3]

Merit. Names the second-victim phenomenon and Scott's recovery trajectory; cites the fatigue-to-error evidence and the demands-resources model without jargon; describes organisation-directed interventions (rosters, workload, team support, measuring burnout) as having the larger effect over individual resilience; recognises the trainee's "bad at my job" statement as the reduced-personal-accomplishment dimension of burnout; ensures the near miss is reported as a systems learning signal. [2] [4]

Fail. Blames or disciplines the trainee by name; focuses only on the prescribing rule and ignores her fatigue and distress; fails to confirm the child is safe; offers no second-victim support and leaves her alone; prescribes resilience without any system change; does not ask about suicidal ideation; treats the near miss as an isolated personal failure rather than a systems signal. [1] [3]

Sample candidate structure

"First, is the child safe — did the dose reach them? Good. The nurse did exactly the right thing. Now I want to look after you. You are exhausted after weeks of poor sleep and a long shift, and a near miss like this can leave any of us shaken — that is a recognised response called the second-victim effect, and it is not a sign you are bad at your job. I am going to hand your remaining high-risk tasks to a colleague tonight so you can stop. I would like us to sit down for a blame-free debrief once things are calm, and I will give you the contact for our practitioner-health service. Can I ask directly — are you safe? Are you having any thoughts of harming yourself? You are not in trouble. This happened because our roster and workload are driving fatigue, and that is a system we own and will fix — capping long shifts, protecting recovery time, and making sure our leaders are accountable for the team's welfare — not something you have to cope with alone." [1] [3] [4]