R. Brent Wright, MD, MMM Associate Dean for Rural Health Innovation University of Louisville School of Medicine Vice-Chair for Rural Health & Associate Professor Department of Family & Geriatric Medicine 05/10/2014 1 Dealing with Difficult Students 20 th annual Preparing health professionals for the 21 st century
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R. Brent Wright, MD, MMM Associate Dean for Rural Health Innovation University of Louisville School of Medicine Vice-Chair for Rural Health & Associate.
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R. Brent Wright, MD, MMMAssociate Dean for Rural Health InnovationUniversity of Louisville School of Medicine
Vice-Chair for Rural Health & Associate Professor
Department of Family & Geriatric Medicine05/10/2014
Dealing with Difficult Students
20th annualPreparing health professionals
for the 21st century
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Three Parts
Learner
Teacher
System
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Difficult learner in medical education
• 9.1% of medical students/young residents are identified as problem or struggling learners
Preceptor Challenges Barriers identified by preceptors preventing the
reporting of a learner who performed poorly:
Dudek NL, Marks MB, Begehr G. Failure to fail: The perspectives of clinical supervisors. Acad Med 2005;80(10 suppl)S84-7.
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Lack of knowledge of what to specifically document
Fear/anticipation of an appeal process
Lack of remediation options
Lack of documentation
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Generational Differences
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Scenario II: Troubling Arrival First Day
Worries of Staff
Documentation
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What would you do?
A. Attribute to Stress & Ignore
B. Monitor for continuance
C. Document and proceed with rotation
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Documentation
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Documentation High quality documentation should be:
Poor or absent documentation can prolong the process of dealing with the difficult student who has become toxic to the learning environment.
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AccessibleAccurate, relevant, and consistent Auditable Clear, concise, and complete Legible/readable Timely, contemporaneous, and sequential ReflectiveRetrievable
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System Factors Work overload (both sides) Inadequate supervision Poor records Poor support systems
- Survey of IM Program Directors - 268 programs responded (72% of 372 programs)
IM residents requiring remediation often have deficiencies in multiple competencies.
Deficiencies across competencies; remediation most successful for Medical Knowledge (86%); least successful for Professionalism (41.2%).
Application materials rarely help to identify individuals at risk.
Performance Deficiencies rarely (5.6%) self-identified by residents.
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Denis M Dupras, Randall S Edson, Andrew J Halvorsen, Robert H Hopkins, Furman S McDonalds. “Problem Residents”: Prevalence, Problems and Remediation in the Era of Core Competencies. The American Journal of Medicine. Volume 125, issue 4, pages 421 - 425
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The Problem Resident (Continued)
Medical Knowledge
Patient Care
Organization/Prioritization
Interpersonal Communication
Professionalism
Practice-based Learning & Improvement
Systems based Practice
0 20 40 60 80 100 120 140 160
47.9
53
41
41.4
41.2
21.8
13.3
85.8
78.4
71.3
61.9
48.5
56
53 RiD with De-ficiencey
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Scenario III
The good student, but…
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What would you do?
Deeper Dive Talk about concerns Deny and Ignore Hope it gets better (on future