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What do I do when my resident ... ?

What do I do when my resident ... ?. Dr Sudha Koppula Department of Family Medicine November 16, 2010. Objectives. By the end of this discussion, you will be able to: Consider situations re: residents in clinical settings Develop approaches to these situations

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What do I do when my resident ... ?

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  1. What do I do when my resident ... ? Dr Sudha Koppula Department of Family Medicine November 16, 2010

  2. Objectives By the end of this discussion, you will be able to: • Consider situations re: residents in clinical settings • Develop approaches to these situations • Develop confidence in your ability to manage these

  3. Clinical Teaching • Why do we choose to do it? • What are the positive aspects? • What is challenging? • How can we make this more rewarding? • What tools do we need?

  4. Scenarios • 9 in total • Based on my residents or a colleague’s • Related to: • Clincal performance • Behaviour as a learner • “Good” residents • Professionalism • Your scenarios welcome also

  5. Abby, PGY-1 • Family Medicine residency for 5 weeks • 3rd continuity clinic • Sees a patient with a painful R knee • Took a good hx; you watched her do knee exam • You ask her what her initial thoughts are re: dx • She isn’t sure - guesses OA, appears unsure • You ask her for other options (ddx) • She appears nervous and says she doesn’t know

  6. Abby, PGY-1 What do I do when my resident reports findings but doesn’t make them meaningful? • Nervous? • Feels rushed? • Used to report findings in medical school and was never asked for her opinion?

  7. Abby, PGY-1 • Ensure “safe” learning environment • Take time for learner • Expect she may see few patients per clinic initially • Communicate • her opinion and thoughts matter • expectation of ownership • practice problem-solving • What fits? • What doesn’t fit? • What if ... ?

  8. Brian, PGY-1 • Halfway through PGY-1 year • You realize every once in a while that there are certain things he should know to do but doesn’t ... • ask red flags in patient with back pain • DRE in patient with rectal bleed • pap with ASCUS x 1 does not need colpo referral • This makes you understandably nervous ...

  9. Brian, PGY-1 What do I do when my resident’s knowledge is substandard? • Does he read around cases? • What else going on in his life preventing him reading? • Does he know where to look up info?

  10. Brian, PGY-1 • Show him a good resource • Ask familiarity with various evidence-based resources • Ask him to verbalize his thought processes • Be open to him speaking about his life circumstances

  11. Carlos, PGY-1 • On Internal Medicine, back for continuity clinic • You ask how the Internal Medicine is going • Worried he may not pass • preceptor says doesn’t manage complicated patients well • gives him “easier” ones; he does well with those • Thinks this is true • he gets muddled if a patient has too many illnesses • You have noticed this to be a problem in your clinic too

  12. Carlos, PGY-1 What do I do when my resident has trouble managing complex patients? • Knowledge issue? • Organization issue? • Feel overwhelmed?

  13. Carlos, PGY-1 • Clarify if concern with knowledge • Consider organizational strategies • Problem lists • What if ... ? • Target practice to increasingly complex patients • Ensure clear communication of thought processes • Encourage him - cares for uncomplicated patients well • May talk to rotation preceptor, ensure he has • opportunity • graduated responsibility • help

  14. Magda, PGY-2 • In your office for AM clinic • Usually clinical assessments are done well • Found she documents patient encounters poorly: • Writes SOAP format but ‘plan’ is in ‘objective’ etc • Lacking detail • Does not flow (new topics mentioned in plan section) • You notice: • getting a lot worse • spending more and more time reviewing her notes

  15. Magda, PGY-2 What do I do when my resident’s documentation is poor? • Is she in a rush to leave clinic? • Comfortable using a keyboard/computer? • Understand the importance of chart notes?

  16. Magda, PGY-2 • Discuss why good chart notes are essential • Show note(s) she has done well • Show one of your notes as example • Go through notes with her before she leaves clinic • Ask what are the barriers to good documentation

  17. Jing-Li, PGY-2 • Transferred from another residency program • Got credit for rotations completed successfully • You give frequent formative feedback • Her response = “ok” and no discussion • Behaviours for which you have suggested specific improvements have not changed • You are frustrated • Jing-Li seems oblivious that this is happening

  18. Jing-Li, PGY-2 What do I do when my resident doesn’t seem to listen to my feedback? • Is she hearing me? • Am I repeating myself? • Does she feel like she can discuss the feedback provided?

  19. Jing-Li, PGY-2 • After feedback given, ask for her next step to improve • Document feedback (fieldnotes) • Encourage discussion about feedback • Verbalize you are interested in her perspective • Her thoughts on how to improve

  20. Mark, PGY-2 • Just started PGY-2 year, enjoying it • Performed well last year • Regard him as a colleague • Focussed, thorough assessments • Reasonable management • Considers patient’s individual circumstances • He arrives, does his work, is pleasant and leaves • Feedback is always positive • You feel like you aren’t teaching him anything ...

  21. Mark, PGY-2 What do I do when my resident is performing well and barely needs my help? • Is this a problem at all? • What else could I teach him? • Awkward to be asking him higher level questions ...

  22. Mark, PGY-2 • Discuss that you are happy with his work & progress • Consider teaching practice management, quality assurance, billing (ask if interested) • Ask “what if” clinical questions

  23. Sushila, PGY-2 • Halfway through PGY-2 year • Been a very conscientious resident so far • Studying for CCFP exam • Seems to be asking you more and more questions that you don’t know the answer to right away • You feel embarrassed that you don’t know the answers • You feel her questioning is genuine and want to help her find the answers • You don’t want to disappoint her as her teacher

  24. Sushila, PGY-2 What do I do when my resident asks me questions that I don’t know how to answer? • Why is she asking? (may be on exam) • Do those questions matter? • Why do the answers matter to her?

  25. Sushila, PGY-2 • Ask the reason for some questions she asks • Ensure she is targeting the correct things to study • Look the answers up together • Different resources • Share them

  26. Denis, PGY-2 • On distributed community rotations • Repeatedly arrives late to your clinic • No chance to review patients beforehand • Missed patient who changed schedule to f/u with him • Once he missed an entire clinic & did not call ahead • Your colleague tells you he was booked for exam practice with him and he didn’t show • You realize Denis is on a slippery slope!

  27. Denis, PGY-2 What do I do when my resident doesn’t keep commitments? • What are the barriers? • Preoccupied with studying • Personal life • Disorganization? • Does he have insight that this is a concern?

  28. Denis, PGY-2 • Communicate professional behaviour, incl punctuality, is constantly assessed because it is important • Ask what the challenges have been • Suggest solutions • Document feedback • Consequences: • Call patient to apologize • Apologize to colleague

  29. Vincentia, PGY-2 • Presents to clinic happy the weather is finally warm • Eager to start clinic • Patients being rude and making “comments” • Can’t understand why • You talk about it with her between patients • As she gets out of her chair, you realize she is wearing • a thin skirt • colourful underwear ...

  30. Vincentia, PGY-2 What do I do when my resident does not dress in a professional manner? • Does she realize what she is wearing? • Is she upset by the comments? • How do I tell her ... ?!?!

  31. Vincentia, PGY-2 • Prevent her from seeing next patient • Communicate you may know what the problem is (consider having another person with you) • Suggest a lab coat • Discuss if she is upset • Emphasize tomorrow is another day ...

  32. Your turn!

  33. Remember … • “Doctor” = “Teacher” • Reward is making a difference

  34. You have ... • Considered scenarios re: residents in clinical settings • Learned approaches to these situations • Interacted with your peers

  35. Let’s Discuss

  36. Thank you Sudha Koppula sudha.koppula@ualberta.ca 780.492.1972 www.familymed.med.ualberta.ca/Home/Education/FacultyDevelopment/Events.cfm

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