1. New Horizons in Medical Education
November , 2015
Weill Cornell Medicine - Qatar

2. Program – Day 2

3. Accreditation
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Weill Cornell Medical College and Weill Cornell Medical College in Qatar.  
Weill Cornell Medical College is accredited by the ACCME to provide continuing medical education for physicians.
Weill Cornell Medical College designates this live activity for a maximum of 8.0 AMA PRA Category 1 Credit(s)™.
Physicians should claim only the credit commensurate with the extent of their participation in the activity.

4. Identifying and Helping the Struggling Learner
G Dodd Denton, MD MPH Stephanie Call, MD

5. Disclosures
We have no Conflicts of Interest to disclose

6. Agenda
Discuss Uses of Evaluation Framework to identify a struggling learner
Domain-based
Developmental
Synthetic
Discuss coaching as a method of remediation

7. Let me tell you about a student
SC started her third year in July on the internal medicine wards.
Three weeks into the six-week rotation, my program support assistant informed me of her midpoint evaluation form:
“Her attending gave her marks of three (9- point scale) for five questions”

8. What did the form show? Low marks (3/9): Good marks (7-8/9):
Clinical Skills (including physical exam)
Professionalism
Interpersonal Skills
Taking Feedback
Good marks (7-8/9):
Medical knowledge, system-based practice, potential as a physician
Overall mark was 7/9: “interpreter” level

9. Interpreting the form The Bad: The Good No comments
Domains open to interpretation
Actual behavior not described.
Difficulty classifying the dysfunction
The Good
Teaches faculty what to observe
Ease of use
Consistency; ability to analyze

10. Analytic Evaluation Framework
knowledge
skills
attitudes/behavior
“KSA”

11. “She’s terrible and I want to fail her right now”
“Tell me about SC”
“She’s terrible and I want to fail her right now”

12. “What did you observe?”
Probably the best question you can ask an evaluator
Detailed description of an observed encounter helps classify the learner’s problem
If the teacher doesn’t know educational terminology, you can classify the problem

13. Using analytic to encompass a complex task
Working on a ward team
Skills …………
Knowledge..
Attitude……..
Writing Notes
Not knowing PE
Resistant to Feedback

14. Developmental Framework
Novice
Advanced beginner
Competent performance
Proficient performance
Intuitive expert
Master
students
residents us
Mind Over Machine (1986)

15. Developmental vs. Analytic
time-line, not static, “becoming” is included; independence is approached
progressively higher function (apprentice model)
Terms can be confusing – what is a novice at professionalism? In choosing an antihypertensive?

16. Developmental Terms: “Novice” Can perform a basic physical exam
“Advanced” learner
“Expert”
Can perform a basic physical exam
Skilled physical examination
Integrates psychosocial issues
into physical exam

17. Really need more data Called the resident on the team
Problems were more extensive
“overtalked” the resident
Overly confident in knowledge
Fellow students didn’t like her
Called her into the office

18. ACGME Competencies Medical Knowledge Patient Care Interpersonal skills
Professionalism
Practice-based learning and Improvement
System-based Practice

19. Professionalism
Knowledge
Patient Care
SBP
PBLI
Communication Skills

20. Cutting through the complexity
reliable
valid
feasible
low tech is good tech
whose time will be spent?

21. How about a different Framework
Synthetic
Developmental
Domain-based
Behaviorial
Where you can visualize
progress

22. Reporter Interpreter Manager-Educator
The RIM/E Framework
Reporter
Interpreter
Manager-Educator

23. Reporter Answers “What” questions
Accurately, reliably assesses and communicates
Complete, Honest
Takes: knowledge, responsibility, hard- work, trust

24. Interpreter Answers “Why” questions Prioritizes, analyzes, synthesizes
Reasonable, not “right” (student)
Takes: more knowledge, confidence, greater independence
“What do you think?”

25. Manager Answers the “How” questions
Proposes actions and options applied to individual patient
Has maturity, skill and knowledge to negotiate with patients on plans
Takes: Knowledge, Maturity, Outward Focus, Reflection

26. Educator Poses questions, independently seeks answers
Shares new knowledge, teaches others, becomes a leader
Takes: insight, confidence, knowledge, skill

27. Symptoms (“Subjective”) Observations (“Objective”)
The Rhythm of RIME
SOAP
Symptoms (“Subjective”) Observations (“Objective”)
Reporter
Interpreter
Manager
Educator
Observation
Assessment
Reflection
Action
Plan

28. Back to SC…
My assistant made an appointment for her. She showed up 30 minutes late, wearing shorts and a tank top.
I asked her how she thought she was doing

29. The New Feedback Sandwich*
Ask
Tell 29

30. Ask Ask learner to assess own performance first Begins a conversation
Ask learner to assess own performance first
What went well and what could have gone better?
What were their goals?
Have they ever seen a patient like this before?
Begins a conversation
Assesses learner’s level of insight
Useful for second-hand feedback 30

31. Tell Tell what you observed: diagnosis and explanation
Tell what you observed: diagnosis and explanation
React to the learner’s observation
Feedback on self-assessment
Include both positive and corrective elements
“I observed….”
Give reasons in the context of well-defined shared goals 31

32. Ask (again)
Ask about recipients understanding and strategies for improvement
What could you do differently?
Give own suggestions
Perhaps even replay parts of the encounter: “show me”
Commit to monitoring improvement together 32