Thinking outside the box

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Presentation transcript:

Thinking outside the box Supporting trainees with specific learning difficulties and neurodevelopmental disorders Mary Barrett, TPD, ID Psychiatry Peter Cutajar, Associate Tutor, Foundation Programme School of Psychiatry Educator’s Day 22nd September 2015

Session focus Neurodiversity Presentation of SLD / NDD in training Bagatelle model Presentation of SLD / NDD in training Workplace issues Education issues Training stages Support Strategies Guidance Case scenarios Resources

Bagatelle Model (Cooper, 2010) Preference for processing information holistically not sequentially Uses imagination to see & manipulate patterns in the information Start with meaning not information Difficulties with working memory Memory tagged to meaning not sequence Problems learning / recalling sequential tasks Problems with personal organisation Difficulties with organisation of meaning

Bagatelle Model

Workplace issues Communication issues Social misunderstandings Literality Social misunderstandings Complaints Responsibility / insight into situations Organisation / planning difficulties Time keeping Better in structured situations

Education issues Supervision Portfolio Engagement Openness to challenge Ability to learn / generalise Portfolio Organisation Multi-source feedback Reflection

Foundation Year Doctor Training stage Consultant Knowledge Responsibility Autonomy Self-management Negotiation skills People-management Higher Trainee Core Trainee Foundation Year Doctor Medical Student

Support strategies: Learning styles Auditory Sounds and words Visual Images, imagining pictures in your mind Kinaesthetic Active learning, doing, touching, practising VARK: visual, auditory, read/write, kinaesthetic http://www.vark-learn.com/english/page.asp?p=questionnaire

Auditory activities Visual activities Kinaesthetic activities Audio tape. Dictation. Lectures. Video conferencing. Radio. Discussion. Using mnemonics to remember facts. Taking part in debates. Reading aloud. Computer based learning. Videos & TV. Photographs. OHP presentations Pictures. Diagrams. Using interactive CD-Roms. Using mind maps, flow charts. Colour coding your notes. Interactive CD-Roms. Field Trips. Computer based learning. Activity-based learning. Visits. Rehearsing and performing. Using movement to stimulate memory. Drawing diagrams and mind maps. Using games.

Support strategies: Attention and concentration Gain person’s attention before giving an instruction Frequent eye contact Identify times and places where the student is more focused Emphasise critical pieces of information Frequent reminders about how much time is left Consider seating arrangements Integrate breaks

Support strategies: Organisation and memory Tangible, short-term steps rather than long-term plans Concrete starting point Structure and routine Sound recording of lectures / meetings Hourly alarm on phone or watch to keep track of time Colour-coded ring-binders / notebooks for each subject area Daily reminder schedules / ‘to do’ lists Highlight or star the most important tasks

‘Autism-related difficulties can be offset’ Questions: Does it affect judgement or performance? Do they have the necessary skills? Does the doctor want to do the job? Is the job possible? Why is it an issue now? Solutions Change the person Change the circumstances Reasonable adjustments

Supervision Set ground rules e.g. agreement on type of feedback Structured sessions, clear aims Ask succinct questions to help the trainee stop and reflect Encourage problem-solving skills Encourage ownership of aspects of SLD/NDD which bring them into conflict with others Provide encouragement Monitor via phone calls or email

Seeking guidance Early recording of concerns Educational supervision process is key Joined up approach CS & ES Midpoint review: plan to address concerns Alert TPD Trainee insight / willingness to engage Patient safety = bottom line

Resources http://www.brainhe.com/ Training Support Service https://www.eastmidlandsdeanery.nhs.uk/page.php?area_id=8