1. 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

2. 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

4. 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

5. Bagatelle Model

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

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

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

10. 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

11. 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.

12. 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

13. 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

14. ‘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

15. 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

16. 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

17. Resources http://www.brainhe.com/ Training Support Service