Dealing with the Difficult Learning Situation

1
Dealing with the Difficult Learning Situation
ltPresentergt
2
Presentation based on materials from
theProduced by Supported by HRSA
Family Medicine Training Grant 1 D15
PE50119-01
3
Goals

• Develop skills to aid the early detection of
  potential problems.
• Present an organized approach to the assessment
  and initial management of challenging
  teacher/learner interactions.
• Review a strategy to help prevent teacher/learner
  problems.

4
The Truth...

• Most of the time things go fine....
• Occasionally ...they dont.
• An ounce of prevention...

5
Prevention

• Primary
• Prevent the problem before it occurs.
• Secondary
• Detect problem early before significant/ more
  difficult to manage.
• Tertiary
• Manage a problem to minimize impact.

6
Primary Prevention

• Know the course expectations.
• Orient the student well.
• Set clear expectations and goals.
• Determine the students goals and expectations.
• Reassess mid-course.

7
Secondary Prevention

• 2o Prevention Early Detection
• Similar to what is done in medicine...
• Detect problem at an early and more easily
  managed stage
• Detect problem early before significant damage or
  injury is done
• We need to do the same when teaching.

8
Secondary Prevention

• Pay attention to your hunches/clues.
• Dont wait.
• Initiate SOAP early.
• Give specific feedback early and watch response.

9
Tertiary Prevention

• If it aint workin....SEEK HELP.
• Dont be a martyr.
• Do not give a passing grade to a learner who has
  not earned it.

10
An Approach to Problem Interactions

• Subjective
• What do you/others think and say?
• Objective
• What are the specific behaviors that are
  observed?
• Assessment
• Your Differential Diagnosis
• Plan
• Gather more data? Solve? Get help?

11
Subjective

• Usually consists of labels.... lazy, slow,
  disinterested , angry etc.
• What do your partners think? ....Office staff?
• Does the student see a problem?

12
Objective

• What SPECIFIC BEHAVIORS indicate a potential
  problem.
• Late to the office three days this week
• Forty minutes with a patient with a cold
• Spoke harshly to receptionist
• Unable to recall info on UTI taught the previous
  day
• Be as specific and detailed as possible.

13
Assessment

• Differential Diagnosis
• ? Cognitive ?
• ? Affective ?
• ? Valuative ?
• ? Environmental ?
• ? Medical ?

14
Assessment

• Cognitive
• ? Knowledge base/ Clinical skills less than
  expected? Why?
• Dyslexia?
• Spatial perception difficulties?
• Communication difficulties?
• Lack of effort/interest?

15
Assessment

• Affective
• Anxiety
• Depression
• Anger
• Fear e.g. of failure, of harming a patient

16
Assessment

• Valuative
• Expects a certain level of work
• Expects a certain grade
• Does not value the rotation
• Does not want to be at your site
• Does not value your teaching
• Holds principles that conflict with
• those of you or your patients

17
Assessment

• Environmental
• Hospital care oriented
• Not used to undifferentiated patient
• Not time sensitive
• Not patient satisfaction oriented

18
Assessment

• Medical
• Clinical depression
• Anxiety disorder/ Panic
• Recovering from recent illness
• Hypothyroidism
• Pre-existing illness in poor control
• Psychosis
• Substance Abuse

19
Plan

• Gather more data?
• Observe and record
• Discuss with student
• Contact School

20
Plan

• Intervene?
• Detailed behavior specific feedback
• Specific recommendations for change
• Set interval for reevaluation

21
Plan (cont.)

• Get Help?
• Get assistance from regional support or school
• Transfer student

22
An Approach to Problem Interactions

• Subjective
• What do you/others think and say?
• Objective
• What are the specific behaviors that are
  observed?
• Assessment
• Your differential diagnosis
• Plan
• Gather more data? Solve? Get help?

23
Teacher Issues

• Consider issues that may affect your teaching
• Personal health, family health, practice issues,
  relationship Issues, staffing, etc
• Is the presence of the learner preventing you
  from doing what needs to be done?
• Are your issues seriously affecting
• the education of the learner?

24
Prevention

• Primary
• Prevent the problem before it occurs.
• Secondary
• Detect problem early before significant/ more
  difficult to manage.
• Tertiary
• Manage a problem to minimize impact.

25
An Approach to Problem Interactions

• Subjective
• What do you/others think and say?
• Objective
• What are the specific behaviors that are
  observed?
• Assessment
• Your differential diagnosis
• Plan
• Gather more data? Solve? Get help?

26
Remember...

• Most of the time things go fine...
• Your time, effort, and expertise is greatly
  appreciated....THANK YOU!