UMMS CRIT Teaching & Leadership: The Reluctant Learner Catherine DuBeau, MD Clinical Chief of Geriatric Medicine Director, Geriatric Fellowship Program

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Your intern admitted an elderly patient from a nursing home with change in mental status. She did a very cursory workup, and did not speak to the family at all. When you question her, she says, “I don’t have time for this. He’s just demented. All these resources going to waste.” Case

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation You point out the features suggestive of delirium, and discuss the importance of prompt dx and management. Your intern rolls her eyes.

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation What is your working diagnosis?

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Definition –A learner who appears not to be eager, willing, and ready to learn what you want to teach Examples… The Reluctant Learner

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Approach the reluctant learner as you would a “tough clinical case” How should you respond to your uneager intern?

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Subjective: Use your experience and opinion to gain an individualized impression of the student’s difficulty. Objective: Document specific examples of the problem Assessment: Diagnose the problem Plan: Develop and implement a plan to address the problem. Use a S.O.A.P. Approach

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Subjective: The Learning Process TEACHERLEARNER CONTENT

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation 1.Take a History 2.Examine the Problem 3.Make the Diagnosis Objective: Be a cool observer, take notes Assessment: Why the reluctance?

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Remember to ASK

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation ASK - Does the learner: Have a problem with Attitude?  Lack of professionalism  Judgmental  “Bleeding heart” who can’t set limits  “Sociopathic” Lack Skill?  Unable to put knowledge to practical use  Uncomfortable asking the questions  Disorganized  Stress, depression Lack Knowledge?  Clinical relevance of material  Missing some “background information”/content

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Plan – Treat the Problem: “The Therapeutic Trial” It usually takes more than one try Keep the focus on the behavior Keep your goal realistic

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Denial “This is not important for good patient care” “I already know all I need to” “There may bean easier way to deal with this kind of problem, but I am doing fine” Contemplation “There are some concrete skills that I can learn and use” “Mastering these skills will make me a better doctor” “Stages of Change” for the Reluctant Learner Determination

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation “RECOVERY” RELAPSE Fatigue Burn out Personal issues Substance use “I understand the importance of this skill to good patient care I can do this”

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Other Chief Residents Program Director Other faculty If you need help – Get a Consult!

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Apply educational theory to your practice: –Learner as active contributor –Take into account their knowledge/ experience –Opportunities for self-learning –Opportunities for self-assessment, reflection –Role modeling The Best Defense…

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation “Reluctance is in the eye of the beholder” The same skills that work with challenging patients work with challenging (reluctant) learners –Use SOAP –Don’t forget to ASK –Get a consult Take Home Points:

UMMS CRIT 2010 Teaching & Leadership: The Reluctant Learner Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation 1.Get a commitment 2.Probe for supporting evidence 3.Reinforce what is right 4.Give guidance about errors or omissions 5.Teach general principles 6.Conclusion Use the One-Minute Preceptor Method