Finding Solutions for Problems Associated with Clinical Teaching

Linda L. Carr, Ph.D. CEO, Faculty Ed Solutions, LLC

Know Do

Learning Objectives

• Some of the problems that can arise when working with trainees and students in clinical practice.

• Empowered to handle problems that arise in your teaching practice.

• Develop specific strategies for assessing, diagnosing, and responding to teaching-related problems.

Diagnose the Problem

Student’s Expectations vs. Student’s Performance

① The expectations must be defined. ② The performance must be defined.

Any difference between performance and expectation must be carefully defined and analyzed.

PEP2 Facilitator’s Module 8 (Handling Problems), p. 8.3.

ABCD&Es of Handling Problems

Assess problem and concerns carefully. Ask the student to self-assess.

ABCD&Es of Handling Problems

Assess problem and concerns carefully. Ask the student for his/her own assessment. Be direct in clarifying expectations, roles, and responsibilities. Focus on behavior, which can be changed.

ABCD&Es of Handling Problems

Assess problem and concerns carefully. Ask the student for his/her own assessment.

Be direct in clarifying expectations, roles, and responsibilities. Focus on behavior, which can be changed.

Categorize/Diagnose problem as accurately as possible—Knowledge? Skill? Behavior?

ABCD&Es of Handling Problems

Assess problem and concerns carefully. Ask the student for his/her own assessment.

Be direct in clarifying expectations, roles, and responsibilities. Focus on behavior, which can be changed.

Categorize/Diagnose problem as accurately as possible—Knowledge? Skill? Behavior? Develop intervention/mutual action plan. Document plan and follow-up.

ABCD&Es of Handling Problems

Assess problem and concerns carefully. Ask the student for his/her own assessment.

Be direct in clarifying expectations, roles, and responsibilities. Focus on behavior, which can be changed.

Categorize/Diagnose problem as accurately as possible—Knowledge? Skill? Behavior?

Develop intervention/mutual action plan. Document plan and follow-up. Evaluate effectiveness of intervention.

ABCDEs Guide

Assess the problem

– Is it real? Is it important?

Be direct

- How would you clarify expectations or performance standards?

Categorize/Diagnose the problem

– knowledge, skill or behavior?

Develop an intervention or educational Rx:

– Education, relearning a skill, practice, modeling and reviewing.

Evaluate effectiveness of intervention PEP2

Example #1 (Max)

A first-year resident is in your office in August. He is eager to learn. When presenting cases the first day, he moves from chief complaint to past history to physical exam and back to history of present illness. Some important information is there, but it is presented in a disorganized way.

 Assess the problem

 Be direct in clarifying expectations or performance standards

 Categorize/Diagnose the problem

 Develop an intervention or educational Rx

Example #2 (Lucy)

A third-year medical student is working with you in October. She has seen an older patient who is complaining of a headache. The student’s differential diagnosis consists totally of AV malformation and tumor.

 Assess the problem

 Be direct direct in clarifying expectations or performance standards

 Categorize/Diagnose the problem

 Develop an intervention or educational Rx

Example #3 (Dawn)

A first-year medical resident is working in your office in December. She has gone in to see one of your long-term elderly patients with multiple medical problems who is complaining of a cough. The resident returns after spending 45 minutes with the patient and admits that she has yet to do the physical examination. You determine that the resident has the necessary knowledge and skills but does not perform to expectation.

What is your next step?

- Do further analysis

- Develop a mutual action plan

- Document plan

- Evaluate effectiveness of intervention

PEP2 Facilitator’s Module 8 (Handling Problems), p. 8.16.

Attitudinal Problems

Many times the problem is primarily one of attitude…



Does the student simply not buy into some of the principles and approaches you stress?

 Does the student not value the experience with you or does not see its relevance to his or her future needs?

PEP2 Facilitator’s Module 8 (Handling Problems), p. 8.10.

Confrontation Techniques

① Identify and clarify differences.

② Directly, openly, and matter of factly, let the person know when you’re confronting him or her and why.

③ Diffuse anger by not taking it personally.

PEP2 Facilitator’s Module 8 (Handling Problems), p. 8.12.

Example #4 (Eric)

A third-year medical student is spending the month of May with you in your office. His histories and physical exams are of reasonable quality, but he shows little interest in obtaining or discussing any psychosocial history. He says that he will take call if required but would prefer to sleep. How would you handle this attitudinal problem?

See Slide Notes

PEP2 Facilitator’s Module 8 (Handling Problems), p. 8.16.

What challenges have you experienced with “Problem Learners” and what solutions have you found?

Summary

① Share and clarify expectations at the start of the clinical rotation.

② Ask the learner to regularly self-assess.

③ Communicate regularly with the learner and the program.

④ Use the “ABCs of Handling Problems.”

⑤ Apply “appropriate” confrontation strategies when needed.

⑥ Problems will still occur but having a systematic and timely approach can help keep small problems small.

LEARN – REFLECT - TEACH

What will you keep the same?

What will you do more of?

What will you do less of?

What will you stop doing?

What will you do differently & how will you do it?

What will you add?