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