A good tip for ensuring your answers are CLEAR, is to imagine you are giving instructions to the worst intern in the department.
Consider a case of lower limb necrotising fasciitis (in septic shock) and the following SAQ: Outline your approach to the management of this patient
- Broad-spectrum – IV Abs
- IVF challenge
- Surgical Review
Could the worst intern in your department execute your plan accurately?
- Meropenum 1g IV, Clindamycin 600mg IV, Vancomycin 30mg/kg IV
- IV Hartmanns bolus with target MAP >65mmHg, up to 30mg/kg, then if MAP remains <65 noradrenaline infusion (4mg in 100mL) to achieve same target
- Titrated aliquots of fentanyl, 50mcg initially then 25mcg q15min until pain controlled
- Emergent Surgical Review so as to organise debridement +/- amputation as source control
Take Home points
Writing clear answers will demonstrate your knowledge and consultant-level communication. It will also help you significantly on the floor at work.
I hope the ‘worst intern in the department’ concept is helpful!