1. Learners in Difficulty

2. Problem Resident
“Trainee who demonstrates a significant enough problem that requires intervention by someone of authority, usually the program director or chief resident.”
ABIM

3. Working with learners in difficulty
Prevention
Identification
SOAP

4. Prevention Primary : Secondary: Tertiary Prevent it before it happens
Early detection
Tertiary
Seek help to manage
the problem

5. Primary Prevention Effective Orientation
Provide learner with objectives
Set clear expectations
Set learner rules
Determine learner’s expectations and objectives
Provide feedback mid-course

6. Secondary Prevention Early Detection/Identification
Three types of difficult learners
Clinical incompetence
Unprofessional behavior
Unprofessional attitudes

7. Clinical Incompetence
Inexperienced
Lack of medical knowledge/skills
Inability to apply knowledge and solve problems

8. Organization of Knowledge
Reduced knowledge
Absent or inaccessible
Dispersed knowledge
Unrelated, out-of-context
Elaborated knowledge
Multiple abstract associations, in context
Compiled knowledge
Concise, experienced

9. What do you do with “reduced” learners?
Provide “advance organizers”
Add structure to clinical experiences
eg. Simulations, mini-assignments relating to clinical cases
Turn “down time” into “clinical learning time”
Ready access to networked computers

10. What do you do with dispersed learners?
Skills or Knowledge??
Skills
“Practice” with SPs, simulators
Knowledge
Use of “real” clinical cases to solve problems
Compare and contrast similarities and differences

11. What do you do with elaborated learners?
Make sure that there is no “premature closure”
Check analytic reasoning pathways
Enquire about non-analytical reasoning
Add readings

12. Unprofessional Behavior
Chronic lateness
Poor cooperation and collaboration
Personal appearance
Lack of integrity
Disrespectful toward others
Lack of empathy/compassion
No self-insight

13. Unprofessional Attitudes
Insecure learner
Prejudiced learner
Apathetic learner
Reductionist learner

14. Tertiary Prevention
Need to “refer” to a more knowledgeable/senior person
SEEK HELP

15. Preceptor Problems Health issues Practice Issues Relationship Issues
Personal, family
Practice Issues
Staffing, financial issues, schedules
Relationship Issues
Personality clash with learner