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Managing Trainees in Difficulty

Managing Trainees in Difficulty. A Unifying Theory of Clinical Practice: RDM-p. A Unifying Theory of Clinical Practice: RDM-p. A unifying theory of clinical practice using three core performance areas of relationship, diagnostics and management, underpinned by professionalism.

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Managing Trainees in Difficulty

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  1. Managing Trainees in Difficulty A Unifying Theory of Clinical Practice: RDM-p

  2. A Unifying Theory of Clinical Practice: RDM-p • A unifying theory of clinical practice using three core performance areas of relationship, diagnostics and management, underpinned by professionalism. • The model is currently being used as a diagnostic tool for defining, exploring and explaining clinically related behaviour in general practice and across a range of hospital specialties, in particular with doctors whose performance has been a cause for concern. © Tim Norfolk Quality in Primary Care 2009, 17 (1), pp37–49

  3. THE CONTEXT • Medical practice involves a subtle interaction between three core activities: • Relationship • Diagnostics • Management • The quality of this interaction is heavily dependent on the professionalism underpinning it. Thus: “Relate to someone, diagnose their needs, manage the process & at all times ensure you act professionally” (hence RDM-p). • The model therefore serves as a diagnostic map for exploring and explaining all behaviour in a medical setting.

  4. Relationship This involves all aspects of how we relate with others in a professional context (whether patients or colleagues/staff), and will include: • Empathy – the desire and ability to take in someone else’s perspective • Communication skills – adapting language and style/manner to suit circumstance • Negotiating skills – drawing patients (& others) into shared search for agreement • Leadership skills – encouraging or persuading patients (& others) to respond willingly/positively to one’s decisions or suggestions (e.g. health promotion) • Advocacy skills – supporting patients (& others) in search of positive solutions.

  5. Diagnostics This involves all aspects of gathering & managing information in search of optimal decision-making (whether for patients, colleagues/staff or oneself). A combination of knowledge and expertise, this will include: • Information gathering skills – judging appropriate range of questions & examinations to elicit enough potentially relevant information • Analytical skills – prioritising elicited information in terms of relevance & significance, and from this identifying viable explanations & management options • Decision-making skills – generating (with patient/others) rational & defensible decisions • Technical & examination skills – using instruments/examining appropriately and effectively.

  6. Management. This involves skills related to the wider handling of one’s professional responsibilities (to patients, colleagues/staff and oneself). The challenge is to keep track of relevant issues over varied lengths of time, and will include: • Managing particular events – e.g. pacing/structuring consultations, writing a batch of letters • Managing comprehensive/ongoing events – e.g. handling timetables over months or years, maintaining adequate records, fulfilling ongoing role(s) within the team • Managing relationships – providing continuity of patient care, monitoring interaction with colleagues/staff (and where necessary taking steps to improve specific relationships) • Managing oneself – monitoring performance/learning/development, and one’s mental & physical health/well-being (to ensure functioning at sufficiently effective/safe level).

  7. Professionalism This centres on respect: to others (relationship), to due process in gathering & analysing information (diagnostics), and to ongoing responsibilities (management). Thus: • Respect for others (patients & colleagues/staff) – non-judgmental approach that treats others, and their contribution, with equal attention and positive intent • Respect for position – fully aware of one’s (a) professional responsibilities & boundaries, (b) potential influence over the behaviour of others, and (c) personal limitations • Respect for protocol – acting in accordance with published or formally agreed guidelines.

  8. Information gathering: Sources • GPs • Nurses • Receptionists • Patients • Educational supervisor • Course co-ordinator • Previous trainers

  9. RDM-p: The Dynamics of Performance

  10. Summary: RDM-p & the 12 WPBA competencies

  11. Trainees in difficulty: Top tips • Meeting to discuss problems • Open and supportive atmosphere • Patient (trainee) centred consultation style • State aim of discussion at start • Start with positive feedback and back up with statements of evidence (helps rapport and encourages open discussion)

  12. Trainees in difficulty: Top tips • Try to establish pattern of problems into either Relationships, Diagnostics, Management or Professionalism and reflect this back to trainee. • Use this to enquire about possible underlying factors causing the problems.

  13. Trainees in difficulty: Top tips • Set SMART objectives • Specific • Measurable • Achievable • Realistic • Time constrained (set date to review progress)

  14. Trainees in difficulty: Top tips • And most importantly if struggling: Ask for help!!!

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