from failure to…
DESCRIPTION
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 times. Success. I held 1,093 patents world-wide “Genius is 1% inspiration, 99% perspiration.” I am best known for this: . - PowerPoint PPT PresentationTRANSCRIPT
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 times
Success
I held 1,093 patents world-wide
“Genius is 1% inspiration, 99% perspiration.”
I am best known for this:
From Failure to…
Who am I ?
I loved sports growing up.I was cut as a sophomore from my
high school basketball team.
SuccessI ended up in the NBA
I won 6 NBA championships
I have appeared on front of the Wheaties box more than any other athlete
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 productions
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
Residents In DifficultyMAJ Scott Grogan
Faculty Development Fellow2 May 2012
Is this resident’s performance below the line??
Objectives
• Discussed your experiences• Listed common resident problems• Categorized those problems• Reviewed a model for dealing with
residents in difficulty• Applied that model to cases
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 policy
Your Experiences…
Why Talk About Residents In Difficulty?
Stakeholders• The resident• Teaching staff• Fellow residents• Program graduates• GME chief and GMEC• Big Navy/ Big Army• Public & society• Patients - we are different
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 share
Three Kinds of Difficulty1. Academic – learning difficulty
– Behavior / attitude– Cognitive– Psychomotor
2. Disciplinary– Usuall breaking rules or laws
3. Impairment / Disability– Avoid temptation to diagnose
Past PD Responses
• Academic 19–Behavior / attitude 12–Knowledge base 3–Others 4
• Discipline 4
• Impairment / disability 9
I Wish I Would Have…
• Identified problem earlier• Documented earlier• Started remediation earlier • Acted earlier
Warning Signs• Avoidance, no interest• Poor performance, task completion• Poor or inappropriate interactions• Tardiness, poor time management• Falling behind in charting• Excessive griping – moody• Complaints by others
Be Careful Saying…
“Just ignore it”
“They’ll grow out of it”
“They’re having personal problems”
“It might be just this once”
Barriers and Pitfalls
• Fear of being the “bad guy”• No staff consensus on “The line”• Personality conflict w/ resident• Personal attacks• Fear avoidance of conversations• Time• Amount of documentation required
Other Pitfalls
Big hearts
Trying to be a provider
Halo Effect
Being a fixer
Conspiracy of Silence
Dr. White Cloud
What would you do now?
A Model to Guide You
Above the line vs. below the line…
Resident prerogative vs.
Program prerogative
Nancy Stevens MD, Univ. of Wash.
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
ResidentAgrees? NOYES Gather data
& evaluate for Perception / Valuedifferences
Provide assistance
Monitor performance, Recommendinterventions
Take administrativeaction
ConcernRemains? NO
YES
Problem Focus & Hypothesize
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
ProbationJustified? YESNO “The Line”
Work-up Cycle
For problems that remain the resident’s prerogative
to resolve
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
“The Line”
Routine Resident EvaluationRegular opportunities for:
–Assessing, guiding, and reassuring– Identify problems for further “work-up”–Acting early–Verbal feedback–Documenting
Problem Focus & Hypothesize
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
“The Line”
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 conversation
Problem Focus & Hypothesize
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
“The Line”
ResidentAgrees?YES
Provide assistance
ConcernRemains? NO
YES
ProbationJustified?
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?!
Problem Focus & Hypothesize
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
“The Line”
ResidentAgrees?YES
Provide assistance
ConcernRemains? NO
YES
ProbationJustified?
ResidentAgrees? NOYES Gather data
& evaluate for Perception / Valuedifferences
ConcernRemains? NO
YES
Task 3: Gather InformationAround 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 consequences
Problem Focus & Hypothesize
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
“The Line”
ResidentAgrees?YES
Provide assistance
ConcernRemains? NO
YES
ProbationJustified?
ResidentAgrees? NOYES Gather data
& evaluate for Perception / Valuedifferences
ConcernRemains? NO
YES
YESNO
Probation Cycle
For problems that become the program’s prerogative
to resolve
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
ResidentAgrees? NOYES Gather data
& evaluate for Perception / Valuedifferences
Provide assistance
Monitor performance, Recommendinterventions
ConcernRemains? NO
YES
Problem Focus & Hypothesize
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
ProbationJustified? YESNO “The Line”
Task 4: Probationary Monitoring• Program level remediation
• Hospital level probation
• Requirements clearly identified
• Assistance / remediation plan explained
• Objective criteria to assess improvement
• Timeline for resolution
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
ResidentAgrees? NOYES Gather data
& evaluate for Perception / Valuedifferences
Provide assistance
Monitor performance, Recommendinterventions
Take administrativeaction
ConcernRemains? NO
YES
Problem Focus & Hypothesize
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
ProbationJustified? YESNO “The Line”
Task 5: Administrative Action• End remediation & begin routine eval
• Begin probation
• End probation
• Extend probation
• Terminate
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 group
The Tardy Resident
Case 1
The Inefficient Resident
Case 2
Case 3
The Depressed Resident
The Severely Ill Resident
Case 4
Reduced Knowledge Resident
Case 5
The Administratively
Challenged Resident
Case 6
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
ResidentAgrees? NOYES Gather data
& evaluate for Perception / Valuedifferences
Provide assistance
Monitor performance, Recommendinterventions
Take administrativeaction
ConcernRemains? NO
YES
Problem Focus & Hypothesize
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
ProbationJustified? YESNO “The Line”
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
ResidentAgrees? NOYES Gather data
& evaluate for Perception / Valuedifferences
Provide assistance
Monitor performance, Recommendinterventions
Take administrativeaction
ConcernRemains? NO
YES
Problem Focus & Hypothesize
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
ProbationJustified? YESNO “The Line”
Documentation
• Document early• Document at the time of the event• Document throughout the work up cycle• Document during the probation cycle• Document, document, document
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 policies
Your Comments
Thank You