Transcript Problem Registrar presentation final

“Trainees in Difficulties”
Moises Fernando Alvarez
&
Wajiha Farhan
July 2016
Statistics
Prevalence 6-9%
• Lack of knowledge 48%
• Poor judgement 44%
• Insufficient use of time 44%
Other causes:
• Attitudinal, interpersonal conflict, family stress,
psychiatrist illness, substance misuse.
Diagnostic Framework and Management Options
• Identification
• Support
• Management
Sharing your experience
• How did you identify your trainee is in difficulties?
• What steps did you follow?
• What was the outcome of your intervention?
Identification of Problems
The “disappearing act”
Ward rage
Career problems
Low work rate
Rigidity
Insight failure
Lack of engagement in educational processes
Inappropriate attitudes
Lack of initiative/appropriate professional engagement
Support
•What works?
 RDM-p (Relationship, Diagnosis, Management-Professionalism)
It is a sequential approach.
 SKIPE (Skills, Knowledge, Internal Factors, Past Factor, External
Factors)
It provides a structure and comprehensive way to connect and
facilitate discussion around the causal factors.
Management
Educational Performance pathway
Identification
Structur ing
and
Recor ding
SJ T, Admin behaviour s, IPUs, Exams,
ESR, ARCPs, 360’s, Absence, GMC, SUI
Contemporary
recording of
events
Gather ing infor mation /r eaching a diagnosis
Evidence
triangulation 3
Confirming and Agreeing evidence
Timely contacts
Assessing r isk to patients10
Using Self-assessment and comparing with Educator
assessment(s)
Building and
maintaining
Relationships
Building tr ust
and
Tr anspar ent
communication
with
Trainee
ES
SMART plans
Clear
summaries
Signposting
process of
reviews
Classifying evidence 13 to reach and share an initial RDM-p
diagnosis (defining the problem)
Reviewing Relevant background information to achieve a
SKIPE understanding 14, 15
CS
Scheme
School (DiD
tutor)
Planning and Explanation
Summar y agr eement on Pr oblem “What” and “Why”
SMART plans and r eview dates
Review and safety nets discussed
Reviews
Including diagnosis and Causes as well as plans.
Others
A snapshot of learning theory
Linking learning outcome, teaching and assessment
Teacher
Perspectives:
Objectives
Student
Perspectives:
Assessment
DLOs*
Teaching Activities
Learning activities
* Desired Learning Outcomes
Teachers and students perspective regarding assessment
Outcomes
Assessment
Bloom's Taxonomy - Cognitive Domaine
High cognitive
demand
Evaluation
Fully functional knowledge
Synthethis
Analysis
Application
Learner has to make deep
connections and meaning
Low order skills
Comprehension
Low
cognitive
demand
Knowledge
These are a means to achieving
fully functional knowledge
Conclusions
Prevention
•The old adage “Prevention better than cure”
•Clarity about the factors that influence poor perfomance
•Development of robust prevention strategies
•Determing what strategies prevented what, how and for whom
Idetification
•Following a framework to identify the problem:
•
•
•
•
Psychological or physical factor?
Work environment?
Deficiency in training?
Is the climate and culture of the organisation a major factor?
Remediation
•A robust and detailed 'diagnosis' should precede treatment
:
Clinical performance/Personality and
Behavioral issues/Health issues/Environmental issues
•Encourage an open and supportive culture within the team