The “Problem Trainee”

The “Problem Trainee”

Ronald D. Szyjkowski, MD, FACGUpstate Medical University

SUNY Syracuse

Objective• Consider the difficulties• Ways to help the trainee succeed• Help your peers & your program respond• Plan interventions• Additional resources

Objective• Consider the difficulties• Ways to help the trainee succeed• Help your peers & your program respond• Plan interventions• Additional resources

The Difficulties the “ProblemTrainee” is Presenting

• Is there impairment?– Mental Illness– Drugs / Alcohol– Illness

“one who is unable to practice medicine with reasonable skill and safety because of mental illness or excessive use or abuse of

drugs; including alcohol”

The DifficultiesSigns of Impairment

• Loss of enthusiasm• Negativity• Cynicism• Antagonism• Complaints– Overworked– Misunderstood

• Isolationism

Hawes, GE Clin NA 5:2 1995

The DifficultiesImpairment

• You will need help.

The Difficulties• Directly affect patient care

and• Do not directly affect patient care

• What did / what could you do?

The Difficulties• Box Groups

The Difficulties• Directly affect patient care

and• Do not affect directly patient care

• What did / what could you do?

The Difficulties

Flip Chart

The Difficulties Directly affect patient care

• Humanistic qualities• Negligence• Ethical conduct• Deficient knowledge base• Poor clinical judgment• Absence / tardiness

The Difficulties Does not directly affect patient care

• Peer interactions• Staff interactions• Cheating• Lack of commitment to learning• Professional behavior• Absence / tardiness

Objective• Consider the difficulties• Ways to help the trainee succeed• Help your peers & your program respond• Plan interventions• Additional resources

Objective• Consider the difficulties• Ways to help the trainee succeed• Help your peers & your program respond• Plan interventions• Additional resources

Objective• Consider the difficulties• Ways to help the trainee succeed• Help your peers & your program respond• Plan interventions• Additional resources

Trainee Success• Define the assessment terms• Set objectives• Explain the appraisal process• Recognize the importance of feedback• Communicate

Have a curriculum

Program SuccessTeachers need to:• Train for the assessment• Know the objectives• Follow the appraisal process• Provide meaningful and timely feedback

Program SuccessTeachers need to:• Train for the assessment• Know the objectives• Follow the appraisal process• Provide meaningful and timely feedback

Program SuccessTeachers need to:• Train for the assessment• Know the objectives• Follow the appraisal process• Provide meaningful and timely feedback

• Have a curriculum...with a plan for intervention

Objective• Consider the difficulties• Ways to help the trainee succeed• Help your peers & your program respond• Plan interventions• Additional resources

InterventionsNeed clear documentation of the problem• Ideas?

InterventionsEscalation

• Documentation of lack of resolution• Inform GME• Plan for remediation– Goals– Dates– Reassessment

InterventionsDocumentation

Need clear documentation of the problem• Specific observations• Date, times and persons involved• Clarify any vagueness• Record what was done and what was planned / instructed• Trainees understanding

Objective• Consider the difficulties• Ways to help the trainee succeed• Help your peers & your program respond• Plan interventions• Additional resources