New Horizons in Medical Education November 20 - 21, 2015 Weill Cornell Medicine - Qatar

Program – Day 2

Accreditation This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Weill Cornell Medical College and Weill Cornell Medical College in Qatar.   Weill Cornell Medical College is accredited by the ACCME to provide continuing medical education for physicians. Weill Cornell Medical College designates this live activity for a maximum of 8.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Identifying and Helping the Struggling Learner G Dodd Denton, MD MPH Stephanie Call, MD

Disclosures We have no Conflicts of Interest to disclose

Agenda Discuss Uses of Evaluation Framework to identify a struggling learner Domain-based Developmental Synthetic Discuss coaching as a method of remediation

Let me tell you about a student SC started her third year in July on the internal medicine wards. Three weeks into the six-week rotation, my program support assistant informed me of her midpoint evaluation form: “Her attending gave her marks of three (9- point scale) for five questions”

What did the form show? Low marks (3/9): Good marks (7-8/9): Clinical Skills (including physical exam) Professionalism Interpersonal Skills Taking Feedback Good marks (7-8/9): Medical knowledge, system-based practice, potential as a physician Overall mark was 7/9: “interpreter” level

Interpreting the form The Bad: The Good No comments Domains open to interpretation Actual behavior not described. Difficulty classifying the dysfunction The Good Teaches faculty what to observe Ease of use Consistency; ability to analyze

Analytic Evaluation Framework knowledge skills attitudes/behavior “KSA”

“She’s terrible and I want to fail her right now” “Tell me about SC” “She’s terrible and I want to fail her right now”

“What did you observe?” Probably the best question you can ask an evaluator Detailed description of an observed encounter helps classify the learner’s problem If the teacher doesn’t know educational terminology, you can classify the problem

Using analytic to encompass a complex task Working on a ward team Skills ………… Knowledge.. Attitude…….. Writing Notes Not knowing PE Resistant to Feedback

Developmental Framework Novice Advanced beginner Competent performance Proficient performance Intuitive expert Master students residents us Mind Over Machine (1986)

Developmental vs. Analytic time-line, not static, “becoming” is included; independence is approached progressively higher function (apprentice model) Terms can be confusing – what is a novice at professionalism? In choosing an antihypertensive?

Developmental Terms: “Novice” Can perform a basic physical exam “Advanced” learner “Expert” Can perform a basic physical exam Skilled physical examination Integrates psychosocial issues into physical exam

Really need more data Called the resident on the team Problems were more extensive “overtalked” the resident Overly confident in knowledge Fellow students didn’t like her Called her into the office

ACGME Competencies Medical Knowledge Patient Care Interpersonal skills Professionalism Practice-based learning and Improvement System-based Practice

Professionalism Knowledge Patient Care SBP PBLI Communication Skills

Cutting through the complexity reliable valid feasible low tech is good tech whose time will be spent?

How about a different Framework Synthetic Developmental Domain-based Behaviorial Where you can visualize progress

Reporter Interpreter Manager-Educator The RIM/E Framework Reporter Interpreter Manager-Educator

Reporter Answers “What” questions Accurately, reliably assesses and communicates Complete, Honest Takes: knowledge, responsibility, hard- work, trust

Interpreter Answers “Why” questions Prioritizes, analyzes, synthesizes Reasonable, not “right” (student) Takes: more knowledge, confidence, greater independence “What do you think?”

Manager Answers the “How” questions Proposes actions and options applied to individual patient Has maturity, skill and knowledge to negotiate with patients on plans Takes: Knowledge, Maturity, Outward Focus, Reflection

Educator Poses questions, independently seeks answers Shares new knowledge, teaches others, becomes a leader Takes: insight, confidence, knowledge, skill

Symptoms (“Subjective”) Observations (“Objective”) The Rhythm of RIME SOAP Symptoms (“Subjective”) Observations (“Objective”) Reporter Interpreter Manager Educator Observation Assessment Reflection Action Plan

Back to SC… My assistant made an appointment for her. She showed up 30 minutes late, wearing shorts and a tank top. I asked her how she thought she was doing

The New Feedback Sandwich* Ask Tell 29

Ask Ask learner to assess own performance first Begins a conversation Ask learner to assess own performance first What went well and what could have gone better? What were their goals? Have they ever seen a patient like this before? Begins a conversation Assesses learner’s level of insight Useful for second-hand feedback 30

Tell Tell what you observed: diagnosis and explanation Tell what you observed: diagnosis and explanation React to the learner’s observation Feedback on self-assessment Include both positive and corrective elements “I observed….” Give reasons in the context of well-defined shared goals 31

Ask (again) Ask about recipients understanding and strategies for improvement What could you do differently? Give own suggestions Perhaps even replay parts of the encounter: “show me” Commit to monitoring improvement together 32