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Case

Case. Your intern admitted an elderly patient from a nursing home with change in mental status and did a very cursory workup, and did not speak to the family at all. When you question her, she says : “I don’t have time for this. He is just demented. All these resources going to waste.”.

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Case

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  1. Case • Your intern admitted an elderly patient from a nursing home with change in mental status and did a very cursory workup, and did not speak to the family at all. When you question her, she says : “I don’t have time for this. He is just demented. All these resources going to waste.”

  2. You point out the features suggestive of delirium, and discuss the importance of prompt dx and management. Your intern rolls her eyes.

  3. What is your working diagnosis?

  4. The Reluctant Learner Angela Jackson, MD Associate Director, Boston University Residency Program in Medicine

  5. Examples of reluctant learners…

  6. The Reluctant Learner • Definition: • A learner who appears not to be eager, willing and ready to learn what you want to teach

  7. Approach the reluctant learner as you would a “tough clinical case”

  8. STEP 1- Make the Diagnosis: “Take a History”

  9. Why the reluctance?

  10. The Learning Process TEACHER LEARNER CONTENT

  11. Remember to ASK

  12. ASK - Does the learner: • Have a problem with Attitude? - judgmental - “bleeding heart” who can’t set limits • Lack Skill? - unable to put knowledge to practical use - uncomfortable asking the questions • Lack Knowledge? - clinical relevance of material - missing some “background information”

  13. The Learning Process TEACHER LEARNER CONTENT

  14. STEP 2 – Treat the Problem: “The Therapeutic Trial” • It usually takes more than one try • Keep the focus on the behavior • Keep your goal realistic

  15. STEP 3 – Get a Consult: • Other Chief Residents • Program Director • Other faculty

  16. “Stages of Change” for the Reluctant Learner “This is not important for good patient care” “I already know all I need to” Denial “There may bean easier way to deal with this kind of problem, but I am doing fine” Contemplation Determination “There are some concrete skills that I can learn and use” “Mastering these skills will make me a better doctor”

  17. “I understand the importance of this skill to good patient care I can do this” “RECOVERY” • Fatigue • Burn out • Personal issues • Substance use RELAPSE

  18. Diagnosis and Treatment Options: • PROBLEM:____________________________________

  19. Take Home Points: • “Reluctance is in the eye of the beholder” • The same skills that work with challenging patients, work with challenging (reluctant) learners

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