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Assessing and Managing Residents in Difficulty

Assessing and Managing Residents in Difficulty. Nancy Stevens, MD, MPH Department of Family Medicine University of Washington May 2013. Residents in Difficulty, Not Difficult Residents. Leaves open mind, more opportunities to intervene Sometimes it is a program in difficulty

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Assessing and Managing Residents in Difficulty

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  1. Assessing and Managing Residents in Difficulty Nancy Stevens, MD, MPH Department of Family Medicine University of Washington May 2013

  2. Residents in Difficulty, Not Difficult Residents • Leaves open mind, more opportunities to intervene • Sometimes it is a program in difficulty • Usually it is both

  3. Three Kinds of Difficulty • Academic: faculty dx learning difficulty • behavior / attitude • cognitive • psychomotor • Disciplinary: due process • usually breaking rules or laws • Impairment / Disability • avoid temptation to diagnose

  4. Quick Quiz • Academic • Disciplinary • Disability

  5. Quick Quiz • Complaints from other residents about this resident’s disorganization and inadequate check out information • Academic • Disciplinary • Disability

  6. Quick Quiz • EHR flags resident reading family members chart • Academic • Disciplinary • Disability

  7. Quick Quiz • Resident uses marijuana legally at party Friday night, fails hospital required drug screen several days later • Academic • Disciplinary • Disability

  8. Quick Quiz • Entering resident asks for accommodation to facilitate treatment of bipolar disorder, has psychotic episode at work • Academic • Disciplinary • Disability

  9. Quick Quiz • Resident asks for accommodation for ADHD after 4 months of failing rotations for which she is on probation • Academic • Disciplinary • Disability

  10. Quick Quiz • Resident with very low scores on patient satisfaction • Academic • Disciplinary • Disability

  11. Quick Quiz • Resident refuses to provide care for patient whose behavior she finds morally objectionable • Academic • Disciplinary • Disability

  12. Quick Quiz • Military resident fails fitness standards • Academic • Disciplinary • Disability

  13. Quick Quiz • Resident avoids pelvic exams when indicated • Academic • Disciplinary • Disability

  14. Educating HR • Disciplinary and Disability difficulties are HR’s responsibility / the resident is an employee • Academic difficulties are the program’s responsibility / the resident is a student

  15. Faculty Roles • Conversation / consensus about expectations before a calamity • Resident education about the process in advance • Structure reduces wasted time / angst /splitting

  16. Faculty Roles Intimate Knowledge of Difficulty Referee (Standing group or specifically appointed) Coach (Advisor or selected for difficulty) Avoid Problems Improve Performance League Manager (Program Director or DIO) Cheerleader (Faculty or staff with professional distance) Distant From Difficulty

  17. Challenges for FM Educators • We prefer to be the coach or cheerleader • Focused on growth potential • Suspicious of faceless discipline • Relationships tempt us to side with residents • Vulnerable to splitting

  18. Prerogatives: Drawing the Line • When a problem arises, who controls whether it gets resolved, the resident or the program? • What about when there is uncertainty?

  19. Quick Quiz • Resident prerogative • Program prerogative • Work-up

  20. Quick Quiz • Resident has 60 incomplete charts during a period of regular work schedule. • Resident prerogative • Program prerogative • Work-up

  21. Quick Quiz • One faculty member finds a resident’s appearance unprofessional but there is no faculty consensus about this. • Resident prerogative • Program prerogative • Work-up

  22. Quick Quiz • Clinic staff concerned a resident is consistently late to clinic • Resident prerogative • Program prerogative • Work-up

  23. Quick Quiz • A resident quietly texts during presentations by others • Resident prerogative • Program prerogative • Work-up

  24. Quick Quiz • R3 has O attendance for the first 3 months of didactics, says she is “so done with that” • Resident prerogative • Program prerogative • Work-up

  25. Quick Quiz • A OB faculty passes you in the stairwell an raises his concern about a resident with poor procedural skills who responds to feedback with little insight about it. • Resident prerogative • Program prerogative • Work-up

  26. Hypothesize and Focus Problems No Agree Agree Routine Resident Evaluation Concerns? no yes RESIDENT PREROGATIVE / WORKUP CYCLE 3 Gather information on differences in Perceptions? Values? 1 2 Provide Assistance Program intervention Justified? Concerns Remain? yes no no yes PROGRAM/FACULTY PREROGATIVE 4 5 Monitor performance, Make recommendations Take administrative action

  27. Thank you!

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