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

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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 - PowerPoint PPT Presentation

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Page 1: Assessing and Managing Residents in Difficulty

Assessing and Managing Residents in Difficulty

Nancy Stevens, MD, MPHDepartment of Family MedicineUniversity of Washington

May 2013

Page 2: Assessing and Managing Residents in Difficulty

Residents in Difficulty, Not Difficult Residents Leaves open mind, more opportunities to

intervene Sometimes it is a program in difficulty Usually it is both

Page 3: Assessing and Managing Residents in Difficulty

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

Page 4: Assessing and Managing Residents in Difficulty

Quick Quiz

Academic Disciplinary Disability

Page 5: Assessing and Managing Residents in Difficulty

Quick Quiz

Complaints from other residents about this resident’s disorganization and inadequate check out information

AcademicDisciplinaryDisability

Page 6: Assessing and Managing Residents in Difficulty

Quick Quiz

EHR flags resident reading family members chart

AcademicDisciplinaryDisability

Page 7: Assessing and Managing Residents in Difficulty

Quick Quiz

Resident uses marijuana legally at party Friday night, fails hospital required drug screen several days later

AcademicDisciplinaryDisability

Page 8: Assessing and Managing Residents in Difficulty

Quick Quiz

Entering resident asks for accommodation to facilitate treatment of bipolar disorder, has psychotic episode at work

AcademicDisciplinaryDisability

Page 9: Assessing and Managing Residents in Difficulty

Quick Quiz

Resident asks for accommodation for ADHD after 4 months of failing rotations for which she is on probation

AcademicDisciplinaryDisability

Page 10: Assessing and Managing Residents in Difficulty

Quick Quiz

Resident with very low scores on patient satisfaction

AcademicDisciplinaryDisability

Page 11: Assessing and Managing Residents in Difficulty

Quick Quiz

Resident refuses to provide care for patient whose behavior she finds morally objectionable

AcademicDisciplinaryDisability

Page 12: Assessing and Managing Residents in Difficulty

Quick Quiz

Military resident fails fitness standards

AcademicDisciplinaryDisability

Page 13: Assessing and Managing Residents in Difficulty

Quick Quiz

Resident avoids pelvic exams when indicated

AcademicDisciplinaryDisability

Page 14: Assessing and Managing Residents in Difficulty

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

Page 15: Assessing and Managing Residents in Difficulty

Faculty Roles Conversation / consensus about

expectations before a calamity Resident education about the process in

advance Structure reduces wasted time / angst

/splitting

Page 16: Assessing and Managing Residents in Difficulty

Improve PerformanceAvoid Problems

Coach(Advisor or selected for difficulty)

League Manager(Program Director or DIO)

Cheerleader(Faculty or staff with professional distance)

Referee(Standing group or specifically appointed)

Intimate Knowledge of Difficulty

Distant From Difficulty

Faculty Roles

Page 17: Assessing and Managing Residents in Difficulty

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

Page 18: Assessing and Managing Residents in Difficulty

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?

Page 19: Assessing and Managing Residents in Difficulty

Quick Quiz

Resident prerogative Program prerogative Work-up

Page 20: Assessing and Managing Residents in Difficulty

Quick Quiz

Resident has 60 incomplete charts during a period of regular work schedule.

Resident prerogativeProgram prerogativeWork-up

Page 21: Assessing and Managing Residents in Difficulty

Quick Quiz

One faculty member finds a resident’s appearance unprofessional but there is no faculty consensus about this.

Resident prerogativeProgram prerogativeWork-up

Page 22: Assessing and Managing Residents in Difficulty

Quick Quiz

Clinic staff concerned a resident is consistently late to clinic

Resident prerogativeProgram prerogativeWork-up

Page 23: Assessing and Managing Residents in Difficulty

Quick Quiz

A resident quietly texts during presentations by others

Resident prerogativeProgram prerogativeWork-up

Page 24: Assessing and Managing Residents in Difficulty

Quick Quiz

R3 has O attendance for the first 3 months of didactics, says she is “so done with that”

Resident prerogativeProgram prerogativeWork-up

Page 25: Assessing and Managing Residents in Difficulty

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 prerogativeProgram prerogativeWork-up

Page 26: Assessing and Managing Residents in Difficulty

Routine Resident Evaluation

Concerns?

RESIDENT PREROGATIVE / WORKUP CYCLE

Program intervention

Justified?ConcernsRemain?

Gather informationon differences

inPerceptions? Values?

Provide Assistance

Hypothesize and Focus Problems AgreeNo Agree

PROGRAM/FACULTY PREROGATIVE

Monitor performance, Make recommendations

Take administrativeaction

yes

no

yes

yes

nono

1 23

4 5

Page 27: Assessing and Managing Residents in Difficulty

Thank you!


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