umms crit teaching & leadership: the reluctant learner catherine dubeau, md clinical chief of...
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UMMS CRIT Teaching & Leadership:The Reluctant Learner
Catherine DuBeau, MDClinical Chief of Geriatric MedicineDirector, Geriatric Fellowship Program
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Your intern admitted an elderly patient from a nursing home
with change in mental status. She did a very cursory
workup, and did not speak to the family at all. When you
question her, she says, “I don’t have time for this. He’s just
demented. All these resources going to waste.”
Case
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
You point out the features suggestive of delirium, and discuss the importance of prompt dx and management.
Your intern rolls her eyes.
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
What is your working diagnosis?
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
• Definition
– A learner who appears not to be eager,
willing, and ready to learn what you want to
teach
• Examples…
The Reluctant Learner
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Approach the reluctant learner as you
would a “tough clinical case”
How should you respond to your uneager intern?
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
• Subjective: Use your experience and opinion to gain an individualized impression of the student’s difficulty.
• Objective: Document specific examples of the problem• Assessment: Diagnose the problem• Plan: Develop and implement a plan to address the problem.
Use a S.O.A.P. Approach
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Subjective: The Learning Process
TEACHER LEARNER
CONTENT
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
1. Take a History
2. Examine the Problem
3. Make the Diagnosis
Objective: Be a cool observer, take notes Assessment: Why the reluctance?
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Remember to ASK
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
ASK - Does the learner:
• Have a problem with Attitude? Lack of professionalism Judgmental
“Bleeding heart” who can’t set limits“Sociopathic”
• Lack Skill?- Unable to put knowledge to
practical use- Uncomfortable asking the questions
- Disorganized- Stress, depression
• Lack Knowledge?- Clinical relevance of material- Missing some “background information”/content
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Plan – Treat the Problem:
“The Therapeutic Trial”
• It usually takes more than one try
• Keep the focus on the behavior
• Keep your goal realistic
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Denial“This is not important for good patient care”
“I already know all I need to”
“There may bean easier way to deal with this kind of problem, but I am doing fine”Contemplation
“There are some concrete skills that I can learn and use”
“Mastering these skills will make me a better doctor”
“Stages of Change” for the Reluctant Learner
Determination
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
“RECOVERY”
RELAPSE
• Fatigue• Burn out• Personal issues• Substance use
“I understand the importance of this skill to good patient careI can do this”
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
•Other Chief Residents• Program Director•Other faculty
If you need help – Get a Consult!
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
• Apply educational theory to your practice:
– Learner as active contributor
– Take into account their knowledge/ experience
– Opportunities for self-learning
– Opportunities for self-assessment, reflection
– Role modeling
The Best Defense…
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
• “Reluctance is in the eye of the beholder”
• The same skills that work with challenging patients work with
challenging (reluctant) learners
–Use SOAP
–Don’t forget to ASK
–Get a consult
Take Home Points:
UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
1. Get a commitment
2. Probe for supporting evidence
3. Reinforce what is right
4. Give guidance about errors or omissions
5. Teach general principles
6. Conclusion
Use the One-Minute Preceptor Method
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