Conflict, complaints and difficult clinical encounters — branching viva

Opening (candidate)

My first move is safety. I confirm there is no weapon, threat or intoxication, keep an exit available, and move the conversation to a private space with the right people. Then I listen actively and ask openly what has happened and what he most needs today, before offering any explanation or defence. [5] [3]

Branch A — The difficult encounter

Examiner: This father generates strong feelings in the team. What makes an encounter "difficult", and whose problem is it? [3]

Candidate: The cardinal feature of a difficult encounter is the clinician's own feeling of being ineffective, frustrated or stuck. That feeling is a diagnostic signal pointing to a mismatch of agenda, expectations or system support, not a property of the family. Re-labelling it as a problem to solve — with the team, structured agendas and supports — usually unlocks the encounter. [3]

Branch B — De-escalation

Examiner: Talk me through the structured verbal de-escalation you would use. [5]

Candidate: I use the Project BETA approach: respect personal space and keep an exit; do not be provocative in posture or tone; establish verbal contact with brief, plain language; identify his wants and feelings; listen closely; agree, or agree to disagree, rather than argue; set clear, reasonable limits; and offer choices and optimism. The counter-intuitive part is that acknowledging the feeling, not defending the content, is what lowers the arousal. [5]

Branch C — A goals-of-care dispute

Examiner: Three months later the same child is in PICU with severe hypoxic brain injury and the parents demand full treatment the team judges non-beneficial. How do you proceed? [6]

Candidate: I would reframe this as unmet hope and inadequate prognostic communication, not parental unreasonableness. I would re-explore what the family most wants for their child, re-share prognosis honestly, seek a shared decision, offer a second opinion, and call a formal ethics consultation or mediation early. The randomised evidence shows ethics consultation reduces non-beneficial treatment and conflict. [6]

Branch D — A formal complaint

Examiner: The family now makes a formal complaint. What does the evidence say about complaints, and how do you respond? [1]

Candidate: Hickson showed that complaints cluster in particular physicians and predict malpractice risk, so complaints are an early warning of communication problems and a safety dataset. I would acknowledge the complaint within the local timeframe, listen, apologise sincerely for any genuine shortcoming, investigate, respond in writing with a timeline and what will change, and feed the learning back to the family and the system. [1]

Branch E — The clinician after the event

Examiner: The registrar involved is now withdrawn and ordering extra tests. What is happening, and what do you do? [9]

Candidate: That is the second-victim trajectory: after an adverse event or complaint a clinician may move through shock and intrusive reflections toward either supported recovery or, if unsupported, anxiety, depression, defensive practice and attrition. I would arrange a debrief, peer and practitioner-health support, and address the systemic contributors so the clinician is supported rather than lost. [9]

Close

Confirm the plan, document factually and contemporaneously, arrange a team debrief, and ensure clinician support and system learning are in place. [5] [9]