Trainees in Difficulty
Jim BoddingtonHackney Trainers’ Workshop Sept 2012
1.45 Intro to session
2.00 Trainees in difficulty: strengths as weaknesses; case studies; diagnosis and resolution.
3.00 Tea
3.15 Issues affecting international medical graduates
4.15 Practicalities: when and how to act
Deanery definitionThe nationally accepted term ‘trainee in difficulty’ describes a doctor in training, who needs extra help and support - beyond that which is normally required - to deal with problem(s) that threaten to delay their completion of a postgraduate training programme. The purpose of identifying a trainee as being ‘in difficulty’ is not to label them; it is to aid the addressing of relevant issues so that they may complete their training successfully.
In pairs
Think of a time when you have had difficulty with your own learning or training.
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How strengths become weaknesses(Hogan and Hogan, 1997)
Strength Dysfunctional behaviour
Enthusiastic Volatile
Shrewd Mistrustful
Independent Detached
Focussed Passive-Aggressive
Confident Arrogant
Charming Manipulative
Vivacious Dramatic
Imaginative Eccentric
Diligent Perfectionist
Dutiful Dependent
Case studies• Individually, think of a trainee you have
supervised and considered to be in difficulty• In groups of 3, share your stories (preserving
confidentiality)• Choose one case to consider in detail, with a view
to an educational diagnosis• You may need to speculate about underlying
causes• Don’t engage in problem solving at this stage• Invest time in problem definition
ASSESSMENT DOMAINS
Health and home
Personality and behaviour
Organisational issues
Clinical capability
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A model for “diagnosis”
Capacity
Learning
Arousal (Motivation)
Distraction
Alienation
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What kind of problem is it?
Type of
problem What is it?
CapacityA fundamental limitation that is unlikely to change
Learning A deficit of knowledge, skills or experience
Arousal/
Motivation
Boredom ; stress; burn-out; low morale
DistractionA problem elsewhere causing a problem here
(or illness/health problems)
AlienationDeep rooted anger/mistrust, leading to sabotage
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Matching resolution to diagnosis
Factor What is it? Resolution
CapacityA fundamental limitation
that is unlikely to change
Change job or role
LearningA deficit of knowledge,
skills or experience
Training (adapted to learning
style); feedback (e.g 360°)
Arousal/
Motivation
Boredom ; stress; burn-
out; low morale
Coaching,
counselling,mentoring; new
project or role
DistractionA problem elsewhere
causing a problem here
Set limits; discuss referral to
appropriate source of help
Alienation
Deep rooted
anger/mistrust leading to
sabotage
Move OUT! Or ring-fence
OR “negotiated settlement”
Case studies (part 2)• Back in the same groups of 3, try applying this
scheme to your case• Clarify the educational diagnosis• What strategies might help resolve the
difficulties?• Role play: trainee, supervisor, observer
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What predicts the likelihood of change?
Do they have the “key” personality traits to help them change?
• Are they stable enough?
• Can they persevere?
Do they have insight?
• Are they psychologically minded?
• Can they reflect on their behaviour and learn from their experience?
Do they want/intend to change?
• Have they a history of successful change attempts?
• What will motivate them to change?
What kind of environment will they be working in?
• What support is available?
• What are the contextual factors that may influence their behaviour?
RECOMMENDED APPROACH
• Act early
• No surprises – involve learner
• If it isn’t written down it hasn’t happened
• Objective – fact not opinion
IMPORTANCE OF EFFECTIVE FEEDBACK
• Ask trainee’s point of view and encourage reflection
• Phrase feedback in descriptive, non-evaluative language
• Be specific not general
• Address decisions and actions rather than assumed intentions and interpretations
• Be constructive – acknowledge appropriate behaviour as well as areas for improvement