1. Giving Feedback, Pt. 2: Challenging Situations and Conversations
Bedi/Fraser Team

2. Objectives Faculty will be able to:
Identify common teaching challenges.
Define their own personal challenges in difficult teaching situations.
Learn brief techniques for confronting, correcting, and teaching in difficult situations.
Develop a personal goal to role model how to handle a challenging interpersonal situation.

3. Characteristics of Difficult Residents

4. Characteristics of Difficult Residents
Poor insight
Challenge your experience
Resist feedback
Unorganized
Arrogant
Overconfident
Insensitive to patient needs
“Unconsciously incompetent”
Lack initiative
Avoidant
Lone ranger
Condescending
Rude to staff
Non-participatory
Slow worker
Lack of attention to detail
Miss the big picture
Poor knowledge base

5. Behaviors of Difficult Residents

6. Behaviors of Difficult Residents
Disrupt work flow
Distracting
Defensive to feedback
Disrupt the team
Avoid the team
Evasive
Sway opinions
Whining
Complaining
Poor role models
Create poor reputation
Lateness
No show for clinic
Arguing/conflict

7. How do we react to them??? Avoid Get angry Talk behind their back
Get rattled
Get off track
Disrupt our work flow
Get upset/cry

8. “Outside” Issues That Can Affect Resident Performance
Relationship/Family stress
Psychiatric illness
Substance abuse
Financial issues

9. “Crucial Conversations”
Strong Emotions
Opposing Opinions
Crucial
Conversations
High Stakes
Patterson, K., Grenny, J., McMillan, R., Switzler, A., Crucial Conversations: Tools for Talking When Stakes are High. New York, NY: McGraw
Hill; 2012.

10. During Stress, it Is Difficult to Act
Do you
Sugarcoat?
Demand your way?
Run or avoid?
Resolve through dialogue and relationship?
(Please note: the remainder of the slides are taken from the two references listed on the last slide.)

11. CC—the Wrong Way…
Withdrawing —Pulling out of communication completely; physical, emotional, psychological
Avoiding —staying away from unsafe topics or issues
Masking —understating, sugar coating, sarcasm, selectively showing
Controlling —coercing others: interrupting, overstating, absolutes
Labeling —trying to win or have others give in through ridiculing their ideas
Attacking —making sure others hurt; emotional, physical, psychological

12. CC—the Right Way: 7 Principles
Start with Heart -focus on what you really want
Learn to Look -is “safety” deteriorating?
Make it Safe -identify mutual purpose
Master My Stories -clarified, unbiased
STATE My Path –
share facts
tell story
ask for others
talk tentatively
encourage testing
Explore Others’ Paths -ask, paraphrase, agree, build, compare
Move to Action -finish clearly

13. “Modifying Motivation: Encouraging Difficult Learners”
“[As residency educators, we have the] challenging opportunity to make sure all learners have both the ability and willingness to do their jobs. Both ability and willingness depend on learners having a high level of independence, self-reliance, self-trust, and the capacity to exercise initiative—in a word, self-esteem.”

14. Motivation allows movement along a continuum
NEGATIVE
POSITIVE
ENCOURAGEMENT
Superstars
Difficult learners

15. Skills of Encouragement
1. Show complete acceptance
Conditional environments only create discouragement.

16. Skills of Encouragement
2. Express empathy
When you can walk in the learner’s shoes, their behaviors, thoughts and feelings make sense.

17. Skills of Encouragement
3. Show confidence
This encourages the learner to be more actively involved.

18. Skills of Encouragement
4. Focus on strengths and assets
Find out all you can about the learner and play to their strengths. Turn liabilities into assets.

19. Skills of Encouragement
5. Focus on Effort and Improvement
Recognize effort (not outcome) and improvement (not comparison to prior performance.)

20. Skills of Encouragement
7. Set learning goals
Performance standards
Short-term
Within learner’s ability level

21. Skills of Encouragement
8. Coach by Encouragement
“See if this works better for you.”
“Why don’t you try a different approach?”
“Let me offer a suggestion?”

22. Skills of Encouragement
9. Give Encouraging Feedback
“Look how much better it went this time.”
“You’re making progress. Hang in there.”
“I hope you feel good about your improvement.”

23. Skills of Encouragement
10. Give encouraging performance evaluations
11. Encourage Self-Evaluation
12. Encourage Self-Encouragement

24. Role Plays Encouragement Crucial Conversations Start with Heart
1. Show complete acceptance
2. Express empathy
3. Show confidence
4. Focus on strengths and assets
5. Focus on Effort and Improvement
6. Facilitate Decision “Doing”
7. Set learning goals
8. Coach by Encouragement
9. Give Encouraging Feedback
10. Give encouraging performance evaluations
11. Encourage Self-Evaluation
12. Encourage Self-Encouragement
Start with Heart
Learn to Look Make it Safe
Master My Stories
STATE My Path
share facts
tell story
ask for others
talk tentatively
encourage testing
Explore Others’ Paths
Move to Action

25. Final Reflections…
What is one thing you can walk away with and do differently after this workshop?

26. Crucial Conversations:
SOME EXAMPLES
Giving a resident negative feedback
Addressing a grave patient care error
Dealing with a resident who is being disrespectful
Addressing a resident who has been rude to a fellow staff member
Confronting a resident about inappropriate comments in a meeting
Giving negative feedback to a boss or superior
Confronting a co-worker who is emotionally fragile
Giving feedback to a resident who just isn’t getting it

27. References
Patterson, K., Grenny, J., McMillan, R., Switzler, A., Crucial Conversations: Tools for Talking When Stakes are High. New York, NY: McGraw Hill; 2012.
Patterson, K., Grenny, J., McMillan, R., Switzler, A., Crucial Confrontations: Tools for Resolving Broken Promises, Violated Expectations, and Bad Beharior. New York, NY: McGraw Hill; 2005.