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Too Many Cooks Spoil the Broth

Lim, Erle C. H. MD; Seet, Raymond C. S. MD

doi: 10.1097/ACM.0b013e318033378e
Other Features: Teaching and Learning Moments

Dr. Lim is associate professor, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Dr. Seet is assistant professor, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

The task was an easy one: to participate in a role-play exercise, in which we would attend to our patient, a SimMan mannequin complaining of chest pain. There were seven of us assigned to this task, chosen from among the 40 tutors being briefed on a forthcoming simulation module for final-year, undergraduate students. We had almost a century and a half of medical and surgical expertise between us. Having been certified in Basic Cardiac Life Support within the past year, I was selected to play the role of code leader. I was, of course, a little uncomfortable with having my colleagues witness any faux pas on my part (and having the performance video-recorded for posterity to boot!), but I reminded myself that I had usually handled codes whilst on call, albeit years ago, with aplomb and facility.

What followed, alas, was a completely lackluster performance. Used to having nurses on hand to assist us, the doctors-turned-nurses of our team had difficulty assembling the Ambu-bag and setting up intravenous drips. The rest of us, acting independently, scrambled around like chickens with our heads cut off, carrying out tasks we thought were appropriate to a resuscitation attempt. With no clear leadership, we looked unprofessional, clumsy, uncoordinated, and foolish. It was, in essence, a fiasco. I had failed utterly in my role as code leader, and our “patient” died.

When we reviewed the videotape, amidst shame-faced laughter, we realized that despite having experience, we lacked clear direction and failed to cooperate. I realized that I should have asserted myself as code leader, assigning specific tasks to each member of the code team (which I would ordinarily have done, in the course of a normal resuscitation attempt). Perhaps, leading a team with so many leaders affected my ability to give orders.

Thankfully, the SimMan sessions we subsequently conducted were far more successful. We of the “not-so-magnificent seven” were heartened by the fact that our disastrous session provided us not only with amusing anecdotes to regale our colleagues and students with, but also very useful lessons for all. It was true, we realized, too many cooks do spoil the broth. Extending the analogy further, the leader, or head chef, has to provide clear guidance and masterful instructions to his sous chefs in order to create a culinary feast. Fortunately for us all, the dish of humble pie we were served turned out to be tasty indeed!

Erle C. H. Lim, MD

Raymond C. S. Seet, MD

© 2007 Association of American Medical Colleges