From Failure to… Who am I ? Teachers said I was “too stupid to learn anything.” I was fired...
-
Upload
phoebe-sims -
Category
Documents
-
view
215 -
download
0
Transcript of From Failure to… Who am I ? Teachers said I was “too stupid to learn anything.” I was fired...
From Failure to…
Who am I ?
Teachers said I was “too stupid to learn anything.”
I was fired from my first two jobs– Not productive enough
I first failed 1000 times
Success
I held 1,093 patents world-wide
“Genius is 1% inspiration, 99% perspiration.”
I am best known for this:
From Failure to…
Who am I ?
I loved sports growing up.
I was cut as a sophomore from my high school basketball team.
Success
I ended up in the NBA
I won 6 NBA championships
I have appeared on front of the Wheaties box more than any other athlete
From Failure to…
Who am I ?
I went to drama school with Bette Davis. I was dismissed for being too quiet and shy
I began my performing career on Broadway, but then was quickly fired
Next, I was dismissed from two different movie productions
Success
As the star in my own TV show in
1948, I went on to win:
– 13 Emmy Awards
– 12 Golden Globes
– A Lifetime Achievement Award
– International Fame
Objectives
• Discussed your experiences
• Listed common resident problems
• Categorized those problems• Reviewed a model for dealing with
residents in difficulty
• Applied that model to cases
Take Home Points
• Act swiftly… investigate and remediate
• Document, document, document
• Focus on program requirements
• Use a model to guide you
• Follow the program’s due process policy
Stakeholders• The resident
• Teaching staff
• Fellow residents
• Program graduates
• GME chief and GMEC
• Big Navy/ Big Army
• Public & society
• Patients - we are different
With Your Neighbor
• Discuss a resident in difficulty that you have worked with
• What were the issues?
• How did you deal with the problem?
• What would you do differently?
• Be prepared to share
Three Kinds of Difficulty1. Academic – learning difficulty
– Behavior / attitude– Cognitive– Psychomotor
2. Disciplinary– Usuall breaking rules or laws
3. Impairment / Disability– Avoid temptation to diagnose
Past PD Responses
• Academic 19–Behavior / attitude 12–Knowledge base 3–Others 4
• Discipline 4
• Impairment / disability 9
I Wish I Would Have…
• Identified problem earlier
• Documented earlier
• Started remediation earlier
• Acted earlier
Warning Signs
• Avoidance, no interest• Poor performance, task completion• Poor or inappropriate interactions• Tardiness, poor time management• Falling behind in charting• Excessive griping – moody• Complaints by others
Be Careful Saying…
“Just ignore it”
“They’ll grow out of it”
“They’re having personal problems”
“It might be just this once”
Barriers and Pitfalls
• Fear of being the “bad guy”• No staff consensus on “The line”• Personality conflict w/ resident• Personal attacks• Fear avoidance of conversations• Time• Amount of documentation required
A Model to Guide You
Above the line vs. below the line…
Resident prerogative
vs.
Program prerogative
Nancy Stevens MD, Univ. of Wash.
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
ResidentAgrees?
NOYES Gather data & evaluate for Perception / Valuedifferences
Provide assistance
Monitor performance, Recommendinterventions
Take administrativeaction
ConcernRemains? NO
YES
Problem Focus & Hypothesize
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
ProbationJustified? YESNO “The Line”
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
“The Line”
Routine Resident Evaluation
Regular opportunities for:–Assessing, guiding, and reassuring– Identify problems for further “work-up”–Acting early–Verbal feedback–Documenting
Problem Focus & Hypothesize
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
“The Line”
Task 1: Problem Focus& Hypothesize
• Discuss with resident (ONLY)
• Possible causes of situation?
• Respect resident’s perspective
• Sort issues according to whether resident agrees or disagrees
• Document conversation
Problem Focus & Hypothesize
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
“The Line”
ResidentAgrees?
YESProvide assistance
ConcernRemains? NO
YES
ProbationJustified?
Task 2: Provide Assistance
• Focus only on area of agreed need• Plan help jointly with the resident• Be specific in comments • Monitor plan for effectiveness• Inform resident when done
A good situation for a learning contract?!
Problem Focus & Hypothesize
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
“The Line”
ResidentAgrees?
YESProvide assistance
ConcernRemains? NO
YES
ProbationJustified?
ResidentAgrees?
NOYES Gather data & evaluate for Perception / Valuedifferences
ConcernRemains? NO
YES
Task 3: Gather InformationAround Differences
• Differences in perception– Assist resident to collect data on future
events
• Differences in values– Help resident articulate value positions – Identify behaviors likely to result in conflict– Communicate the likely consequences
Problem Focus & Hypothesize
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
“The Line”
ResidentAgrees?
YESProvide assistance
ConcernRemains? NO
YES
ProbationJustified?
ResidentAgrees?
NOYES Gather data & evaluate for Perception / Valuedifferences
ConcernRemains? NO
YES
YESNO
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
ResidentAgrees?
NOYES Gather data & evaluate for Perception / Valuedifferences
Provide assistance
Monitor performance, Recommendinterventions
ConcernRemains? NO
YES
Problem Focus & Hypothesize
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
ProbationJustified? YESNO “The Line”
Task 4: Probationary Monitoring
• Program level remediation
• Hospital level probation
• Requirements clearly identified
• Assistance / remediation plan explained
• Objective criteria to assess improvement
• Timeline for resolution
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
ResidentAgrees?
NOYES Gather data & evaluate for Perception / Valuedifferences
Provide assistance
Monitor performance, Recommendinterventions
Take administrativeaction
ConcernRemains? NO
YES
Problem Focus & Hypothesize
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
ProbationJustified? YESNO “The Line”
Task 5: Administrative Action
• End remediation & begin routine eval
• Begin probation
• End probation
• Extend probation
• Terminate
Cases• In groups discuss the cases…
• Above or below the line?• What course of action would you
take?• How would you document this
situation?• Appoint a spokesperson• Share your findings with the larger group
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
ResidentAgrees?
NOYES Gather data & evaluate for Perception / Valuedifferences
Provide assistance
Monitor performance, Recommendinterventions
Take administrativeaction
ConcernRemains? NO
YES
Problem Focus & Hypothesize
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
ProbationJustified? YESNO “The Line”
Routine Resident Evaluation
PROBATION CYCLEProgram/Faculty Prerogatives
ResidentAgrees?
NOYES Gather data & evaluate for Perception / Valuedifferences
Provide assistance
Monitor performance, Recommendinterventions
Take administrativeaction
ConcernRemains? NO
YES
Problem Focus & Hypothesize
WORK-UP CYCLEResident Prerogatives
NOYES Concerns?
ProbationJustified? YESNO “The Line”
Documentation
• Document early
• Document at the time of the event
• Document throughout the work up cycle
• Document during the probation cycle
• Document, document, document
Take Home Approach
• Act swiftly… investigate and remediate
• Document, document, document
• Focus on program requirements
• Use a model to guide you
• Follow your due process policies