1. C. Jessica Dine, MD MSHPR ASH Training Program Directors’ Workshop December 4, 2015 When your colleagues are millennials: Communication and remediation

2. 2 Disclosures  No relevant financial disclosures  My focus is on assessment Thanks to Karen Warburton

3. 3 Objectives 1.Describe characteristics of the millennial generation relevant to communication 2.Define professional communication 3.Identify unique communication styles and needs of the millennials 4.Outline general remediation plans 5.Breakout session: design remediation plans for millennials with deficits in communication

4. 4 Objectives 1.Describe characteristics of the millennial generation relevant to communication 2.Define professional communication 3.Identify unique communication styles and needs of the millennials 4.Outline general remediation plans 5.Breakout session: design remediation plans for millennials with deficits in communication

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7. 7 Presidents 1980 to 2000 Jimmy Carter1977 to 1981 Ronald Reagan1981 to 1989 George Bush1989 to 1993 Bill Clinton1993 to 2001 George W. Bush2001 to 2009 Barak Obama2009 to present

8. 8 Headlines 1980 to 2000 1980sFirst cases of AIDS in the U.S. reported John Lennon assassinated in New York City Challenge shuttle explodes, killing all 7 members The Fall of the Berlin Wall Sandra Day O'Connor First Woman U.S. Supreme Court Justice Exxon Valdez oil spill 1990sNelson Mandela released German reunification 1990-1991: Gulf War I Yugoslav Civil War (1991-2001) Fall of the USSR The Internet becomes available Rwanda 2000’sTerrorist attacks on the U.S. Sniper shootings nears D.C. Iraq war Hurricane Katrina Debate over wall street bailout Barak Obama’s inaugeration

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10. 10  Optimistic  Generous  Practical  Team oriented  Open to change  Used to feedback  Hard working  Not spontaneous  Not introspective

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13. 13 Comparing Generations Hammill. FDU Magazine Online. 2005.

14. 14 Objectives 1.Describe characteristics of the millennial generation relevant to communication 2.Define professional communication 3.Identify unique communication styles and needs of the millennials 4.Outline general remediation plans 5.Breakout session: design remediation plans for millennials with deficits in communication

15. 15 Professional Communication  Any form of communication within a workplace context  ACGME requirement

16. 16 ACGME Core Competencies  Patient care  Medical knowledge  Communication  Professionalism  Systems based practice  Practice based learning and improvement

17. 17 ACGME Core Competencies  Patient care  Medical knowledge  Communication  Professionalism  Systems based practice  Practice based learning and improvement

18. 18 Reporting Milestones - Communication ICS1Communicates effectively with patients and caregivers. ICS2Communicates effectively in interprofessional teams (e.g., with peers, consultants, nursing, ancillary professionals, and other support personnel). ICS3Appropriate utilization and completion of health records.

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20. 20 Patient Communication Duffy. Academic Medicine. 2004.

21. 21 Reporting Milestones - Communication ICS1Communicates effectively with patients and caregivers. ICS2Communicates effectively in interprofessional teams (e.g., with peers, consultants, nursing, ancillary professionals, and other support personnel). ICS3Appropriate utilization and completion of health records.

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23. 23 Interprofessional Communication Frankel. The Joint Commission Journal on Quality and Patient Safety. 2007.

24. 24 Interprofessional Communication Frankel. The Joint Commission Journal on Quality and Patient Safety. 2007.

25. 25 Reporting Milestones - Communication ICS1Communicates effectively with patients and caregivers. ICS2Communicates effectively in interprofessional teams (e.g., with peers, consultants, nursing, ancillary professionals, and other support personnel). ICS3Appropriate utilization and completion of health records.

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28. 28 Objectives 1.Describe characteristics of the millennial generation relevant to communication 2.Define professional communication 3.Identify unique communication styles and needs of the millennials 4.Outline general remediation plans 5.Breakout session: design remediation plans for millennials with deficits in communication

29. 29 Communication and Millennials PatientsWant to make a difference Constant, ongoing feedback Less spontaneity TeamsTeam-oriented Constant, ongoing feedback Conflict resolution Health records and other written communication Technologically savy Multi-taskers Instant results

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31. 31 Communicating with Millennials  Full transparency  Goal setting Relevance Experience  Work-life integration (not balance) Social connections while at work Work from home too  Multiple mediums E-mail is “old school” Address expectations

32. 32 Essary. The Journal of Physician Assistant Education. 2011. Social Media

33. 33 Objectives 1.Describe characteristics of the millennial generation relevant to communication 2.Define professional communication 3.Identify unique communication styles and needs of the millennials 4.Outline general remediation plans 5.Breakout session: design remediation plans for millennials with deficits in communication

34. 34 Struggling Learner  2000 survey of US IM Program Directors 94% of PDs reported problem residents Point prevalence of problem residents 6.9%  Repeat survey in 2008 Similar results  Outside of internal medicine 30 year retrospective review in a single surgery program-> 17 struggling learners  Outside of the US 10 year retrospective review of Canadian GME programs-> 3% of residents

35. 35 Remediation by Competency Riebschleger. JGME. 2013.

36. 36 Remediation by Competency Guerrasio. Academic Medicine. 2014.

37. 37 Remediation – Specifics Yao. JAMA. 2000.

38. 38 Differential Diagnosis  Psychosocial stress  Psychiatric diagnosis Depression Personality disorder  Impairment  Learning disability  Poor preparation  Wrong career (or program) choice

39. 39 Remediation Strategies  Not happening very often 2008 IMPD Survey –Only 38% of residency program directors reported remediating any resident Retrospective review of surgical residents –15/17 graduated with same deficits that were first reported  Learners are identified late Barriers = Inaccurate evaluations, denial, remediation time-intensive

40. 40 Remediation Strategies University of Colorado School of Medicine Remediation Program  Largest, most comprehensive study to date  151 learners referred over 6 year period 43% residents, 9% post-residency  Standardized assessment process by a remediation specialist  Individualized learning plans  Independent reassessment

41. 41 Remediation Strategies Guerrasio. Academic Medicine. 2014. Mean number of hours of faculty face time require for remediation was 18.8 per learner

42. 42 Remediation Outcomes Guerrasio. Academic Medicine. 2014. Poor professionalism was the only predictor of being placed on probation (P < 0.001) Per hour, faculty face time reduced the odds of probation by 3.1% and all negative outcomes by 2.6%

43. 43 Struggling Learner Clinical Competency Committee Assessment Identification of the Struggling Learner

44. 44 Assessment Pre-interview assessment Interview Rule out exacerbating factors Otherwise, external referral Identification of Clinical Deficiency Diagnosing the Problem

45. 45 Diagnosing the Clinical Deficiency Fund of knowledge Clinical reasoning Organization and efficiency Professionalism Communication skills

46. 46 Struggling Learner Clinical Competency Committee Assessment Pre-interview assessment Interview Rule out exacerbating factors Otherwise, external referral Identification of Clinical Deficiency Fund of knowledge Clinical reasoning Organization and efficiency Professionalism Communication skills The Whole Process

47. 47 Development of a Written Coaching Plan Coaching Fund of knowledge Clinical reasoning Organization and efficiency Professionalism Communication skills  Requires direct observation, real-time feedback and time for reflection  Learner must know the stakes and know there are no guarantees  Must involve reassessment

48. 48 Coaching Plan

49. 49 Coaching Plan for Millennials  Authority figures Who are you and why should they trust you Have proofs (assessment data)  Set goals Specific goals based on the data Ideally relevant to the learner Time-line for observation and reassessment  Be transparent  Frequent feedback Consider real-time access or real-time feedback

50. 50 An Example  Name each steps  Create systems and frameworks for things we often take for granted  Name each steps  Create systems and frameworks for things we often take for granted

51. 51 Conclusions 1.Millennials are confident, connected and open to change Patient centered (want to help) Team-oriented Communicate using multiple mediums Expect immediate answers Desire frequent or even on-going feedback 2.Coaching/remediation works but is resource-intense Set specific goals Frequent feedback and reassessment

52. 52 Objectives 1.Describe characteristics of the millennial generation relevant to communication 2.Define professional communication 3.Identify unique communication styles and needs of the millennials 4.Outline general remediation plans 5.Breakout session: design remediation plans for millennials with deficits in communication

53. 53 Questions?