Who am I Teachers said I was too stupid to learn anything I was fired from my first two jobs Not productive enough I first failed 1000 times Success I held 1093 patents worldwide Genius is 1 inspiration 99 perspiration ID: 618918
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Slide1Slide2
From Failure to…
Who am I ?
Teachers said I was “too stupid to learn anything.”
I was fired from my first two jobs
Not productive enough
I first failed 1000 timesSlide3
Success
I held 1,093 patents world-wide
“Genius is 1% inspiration, 99% perspiration.”
I am best known for this: Slide4Slide5
From Failure to…
Who am I ?
I loved sports growing up.
I was cut as a sophomore from my high school basketball team.Slide6
Success
I ended up in the NBA
I won 6 NBA championships
I have appeared on front
of the
Wheaties
box more
than any other athleteSlide7
From Failure to…
Who am I ?
I went to drama school with Bette Davis. I was dismissed for being too quiet and shy
I began my performing career on Broadway, but then was quickly fired
Next, I was dismissed from two different movie productionsSlide8
Success
As the star in my own TV show in
1948, I went on to win:
– 13 Emmy Awards
– 12 Golden Globes – A Lifetime Achievement Award
– International Fame
Slide9Slide10
Residents In Difficulty
MAJ Scott Grogan
Faculty Development Fellow
2 May 2012Slide11
Is this resident’s performance below the line??Slide12
Objectives
Discussed your experiences
Listed common resident problems
Categorized those problems
Reviewed a model for dealing with residents in difficulty
Applied that model
to casesSlide13
Take Home Points
Act swiftly… investigate and remediate
Document, document, document
Focus on program requirements
Use a model to guide you
Follow the program’s due process
policySlide14
Your Experiences…
Why Talk About Residents In Difficulty?Slide15
Stakeholders
The resident
Teaching staff
Fellow residents
Program graduates
GME chief and GMEC
Big Navy/ Big Army
Public & society
Patients -
we are differentSlide16
With Your Neighbor
Discuss a resident in difficulty that you have worked with
What were the issues?
How did you deal with the problem?
What would you do differently?
Be prepared to shareSlide17
Three Kinds of Difficulty
1.
Academic
– learning difficulty
Behavior / attitude
Cognitive
Psychomotor
2.
Disciplinary
Usuall
breaking rules or laws
3.
Impairment / Disability
Avoid temptation to diagnoseSlide18
Past PD Responses
Academic 19
Behavior / attitude 12
Knowledge base 3
Others 4
Discipline 4
Impairment / disability 9Slide19
I Wish I Would Have…
Identified problem earlier
Documented earlier
Started remediation earlier
Acted earlierSlide20
Warning Signs
Avoidance, no interest
Poor performance, task completion
Poor or inappropriate interactions
Tardiness, poor time managementFalling behind in chartingExcessive griping – moody
Complaints by othersSlide21
Be Careful Saying…
“Just ignore it”
“They’ll grow out of it”
“They’re having personal problems”
“It might be just this once”Slide22
Barriers and Pitfalls
Fear of being the “bad guy”
No staff consensus on “The line”
Personality conflict
w/ residentPersonal attacksFear avoidance of conversations
Time
Amount of documentation requiredSlide23
Other Pitfalls
Big hearts
Trying to be
a provider
Halo Effect
Being a fixer
Conspiracy of SilenceSlide24
Dr. White Cloud
What would you do now?Slide25
A Model to Guide You
Above the line vs. below the line…
Resident prerogative
vs.
Program prerogative
Nancy Stevens MD, Univ. of Wash.Slide26
Routine
Resident Evaluation
PROBATION CYCLE
Program/Faculty
Prerogatives
Resident
Agrees?
NO
YES
Gather data
& evaluate for
Perception / Value
differences
Provide
assistance
Monitor
performance
,
Recommend
interventions
Take
administrative
a
ction
Concern
Remains?
NO
YES
Problem Focus
& Hypothesize
WORK-UP CYCLE
Resident
Prerogatives
NO
YES
Concerns?
Probation
Justified?
YES
NO
“The Line”Slide27
Work-up Cycle
For problems that remain the
resident’s
prerogative
to resolveSlide28
Routine
Resident Evaluation
PROBATION CYCLE
Program/Faculty
Prerogatives
WORK-UP CYCLE
Resident
Prerogatives
NO
YES
Concerns?
“The Line”Slide29
Routine Resident Evaluation
Regular opportunities for:
Assessing, guiding, and reassuring
Identify problems for further “work-up”
Acting early
Verbal feedback
DocumentingSlide30
Problem Focus
& Hypothesize
Routine
Resident Evaluation
PROBATION CYCLE
Program/Faculty
Prerogatives
WORK-UP CYCLE
Resident
Prerogatives
NO
YES
Concerns?
“The Line”Slide31
Task 1: Problem Focus
& Hypothesize
Discuss with resident (ONLY)
Possible causes of situation?
Respect resident’s perspective
Sort issues according to whether resident agrees or disagrees
Document conversationSlide32
Problem Focus
& Hypothesize
Routine
Resident Evaluation
PROBATION CYCLE
Program/Faculty
Prerogatives
WORK-UP CYCLE
Resident
Prerogatives
NO
YES
Concerns?
“The Line”
Resident
Agrees?
YES
Provide
assistance
Concern
Remains?
NO
YES
Probation
Justified?Slide33
Task 2: Provide Assistance
Focus only on area of agreed need
Plan help jointly with the resident
Be specific in comments
Monitor plan for effectiveness
Inform resident when done
A good situation for a learning contract?!Slide34
Problem Focus
& Hypothesize
Routine
Resident Evaluation
PROBATION CYCLE
Program/Faculty
Prerogatives
WORK-UP CYCLE
Resident
Prerogatives
NO
YES
Concerns?
“The Line”
Resident
Agrees?
YES
Provide
assistance
Concern
Remains?
NO
YES
Probation
Justified?
Resident
Agrees?
NO
YES
Gather data
& evaluate for
Perception / Value
differences
Concern
Remains?
NO
YESSlide35
Task 3: Gather Information
Around Differences
Differences in perception
Assist resident to collect data on future events
Differences in values
Help resident articulate value positions
Identify behaviors likely to result in conflict
Communicate the likely consequencesSlide36
Problem Focus
& Hypothesize
Routine
Resident Evaluation
PROBATION CYCLE
Program/Faculty
Prerogatives
WORK-UP CYCLE
Resident
Prerogatives
NO
YES
Concerns?
“The Line”
Resident
Agrees?
YES
Provide
assistance
Concern
Remains?
NO
YES
Probation
Justified?
Resident
Agrees?
NO
YES
Gather data
& evaluate for
Perception / Value
differences
Concern
Remains?
NO
YES
YES
NOSlide37
Probation Cycle
For problems that become the
program’s
prerogative
to resolveSlide38
Routine
Resident Evaluation
PROBATION CYCLE
Program/Faculty
Prerogatives
Resident
Agrees?
NO
YES
Gather data
& evaluate for
Perception / Value
differences
Provide
assistance
Monitor performance,
Recommend
interventions
Concern
Remains?
NO
YES
Problem Focus
& Hypothesize
WORK-UP CYCLE
Resident
Prerogatives
NO
YES
Concerns?
Probation
Justified?
YES
NO
“The Line”Slide39
Task 4:
Probationary Monitoring
Program level remediation
Hospital level probation
Requirements clearly identified
Assistance / remediation plan explained
Objective criteria to assess improvement
Timeline for resolutionSlide40
Routine
Resident Evaluation
PROBATION CYCLE
Program/Faculty
Prerogatives
Resident
Agrees?
NO
YES
Gather data
& evaluate for
Perception / Value
differences
Provide
assistance
Monitor
performance
,
Recommend
interventions
Take
administrative
a
ction
Concern
Remains?
NO
YES
Problem Focus
& Hypothesize
WORK-UP CYCLE
Resident
Prerogatives
NO
YES
Concerns?
Probation
Justified?
YES
NO
“The Line”Slide41
Task 5:
Administrative Action
End remediation & begin routine
eval
Begin probation
End probation
Extend probation
TerminateSlide42
Cases
In groups discuss the cases…
Above or below the line?
What course of action would you take?
How would you document this situation?
Appoint a spokesperson
Share your findings with the larger groupSlide43
The Tardy Resident
Case 1Slide44
The Inefficient Resident
Case 2Slide45
Case 3
The Depressed ResidentSlide46
The Severely
I
ll Resident
Case 4Slide47
Reduced Knowledge Resident
Case 5Slide48
The Administratively Challenged Resident
Case 6Slide49
Routine
Resident Evaluation
PROBATION CYCLE
Program/Faculty
Prerogatives
Resident
Agrees?
NO
YES
Gather data
& evaluate for
Perception / Value
differences
Provide
assistance
Monitor
performance
,
Recommend
interventions
Take
administrative
a
ction
Concern
Remains?
NO
YES
Problem Focus
& Hypothesize
WORK-UP CYCLE
Resident
Prerogatives
NO
YES
Concerns?
Probation
Justified?
YES
NO
“The Line”Slide50
Routine
Resident Evaluation
PROBATION CYCLE
Program/Faculty
Prerogatives
Resident
Agrees?
NO
YES
Gather data
& evaluate for
Perception / Value
differences
Provide
assistance
Monitor
performance
,
Recommend
interventions
Take
administrative
a
ction
Concern
Remains?
NO
YES
Problem Focus
& Hypothesize
WORK-UP CYCLE
Resident
Prerogatives
NO
YES
Concerns?
Probation
Justified?
YES
NO
“The Line”Slide51Slide52
Documentation
Document early
Document at the time of the event
Document throughout the work up cycle
Document during the probation cycle
Document, document, documentSlide53
Take Home Approach
Act swiftly… investigate and remediate
Document, document, document
Focus on program requirements
Use a model to guide you
Follow your due process policiesSlide54
Your CommentsSlide55
Thank You