1. “Trainees in Difficulties”
Moises Fernando Alvarez & Wajiha Farhan July 2016

2. Statistics Prevalence 6-9% Lack of knowledge 48% Poor judgement 44%
Insufficient use of time 44%
Other causes:
Attitudinal, interpersonal conflict, family stress, psychiatrist illness, substance misuse.
6-9 in every 100 can be in difficulty , but only a small proportion will have serious issues.
Most frequent causes of under performance are ….

3. Diagnostic Framework and Management Options
Identification
Support
Management

4. Sharing your experience
How did you identify your trainee is in difficulties?
What steps did you follow?
What was the outcome of your intervention?

5. Identification of Problems
The “disappearing act”
Ward rage
Low work rate
Lack of engagement in educational processes
Career problems
Rigidity
Insight failure
Inappropriate attitudes
Root cause may lie somewhere else( competence/ conduct, health problem or an issue in or out of work
2)Knowledge: generally poor, specific areas, problem with application or lack of insight , which is dangerous
Find out through AKT results, curriculum coverage, trainees self assessment, debriefs, WPBA
3)Motivation:Ask them about theor goals and outcomes, core values, motivational interviweing
4)Uncertainity: discuss complexity theory , hiw most of us operate in zone B btw competence & chaos, don’t get flustered, things that help: engage in deeper dialogue with pt by exploring ICE, shared decision making , you can facilitate decision making , rather than giving answers
5) Holding hands: transition curve , moving from unconscious incompetance to cpnscious competency, encourage to discuss their anxieties
6) Muddly consulter: lack of structure, lack of problem solving skills, poor time keeping
7) Bypass syndrome
Lack of initiative/appropriate professional engagement

6. Support
What works?
RDM-p (Relationship, Diagnosis, Management-Professionalism)
It is a sequential approach.
SKIPE (Skills, Knowledge, Internal Factors, Past Factor, External Factors)
It provides a structure and comprehensive way to connect and
facilitate discussion around the causal factors.

7. Management

8. A snapshot of learning theory
Linking learning outcome, teaching and assessment
Teachers and students perspective regarding assessment

9. Bloom's Taxonomy - Cognitive Domaine
High cognitive
demand
Evaluation
Fully functional knowledge
Learner has to make deep connections and meaning
Synthethis
Analysis
Application
Low order skills
These are a means to achieving fully functional knowledge
Comprehension
Knowledge
Low cognitive
demand

10. Conclusions Prevention The old adage “Prevention better than cure”
Clarity about the factors that influence poor perfomance
Development of robust prevention strategies
Determing what strategies prevented what, how and for whom
Idetification
Following a framework to identify the problem:
Psychological or physical factor?
Work environment?
Deficiency in training?
Is the climate and culture of the organisation a major factor?
Remediation
A robust and detailed 'diagnosis' should precede treatment :
Clinical performance/Personality and Behavioral issues/Health issues/Environmental issues
Encourage an open and supportive culture within the team