Your intern rolls her eyes.
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- Sharlene McGee
- 8 years ago
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1 Case Your intern admitted a patient with pneumonia and symptoms of heroin withdrawal. She did a very cursory workup, and did not treat the patient s withdrawal symptoms at all. When you question her, she says : What s the point? She is just going to leave AMA anyway. I don t have time for this.
2 You point out the importance of managing withdrawal symptoms in an acutely ill patient and offer to review the management of heroin withdrawal with her. Your intern rolls her eyes.
3 What is the diagnosis?
4 The Reluctant Learner Angela Jackson, MD Vice Chair for Education Department of Medicine
5 Goals of the session: Define Reluctant Learner Diagnose the reluctant learner Discuss effective approaches to engage the reluctant learner
6 The Reluctant Learner Definition: A learner who appears not to be eager, willing and ready to learn what you want to teach
7 Examples of reluctant learners
8 Examples of reluctant learners The Know It All The Minimizer Passive-Aggressive The Lazy Learner Excuses, excuses Not my job! Disinterested/Bored The Head Bobber
9 The Reluctant Learner How do you know when you have one? Why is it so easy to tell?
10 Why the reluctance?
11 The Reluctant Learner Definition: A learner who appears not to be eager, willing and ready to learn what you want to teach
12 Reluctance is not a permanent personality trait, but a modifiable state
13 Approach the reluctant learner as you would a clinical case
14 STEP 1- Diagnose the Problem STEP 2 -Treat the Problem STEP 3- Get a Consult
15 1- Diagnose the Problem
16 The Learning Process TEACHER LEARNER CONTENT
17 1- Diagnose the Problem: Diagnose the Learner: ASK
18 ASK - Does the learner: Have a problem with Attitude? - judgmental - bleeding heart who can t set limits Lack Skill? - unable to put knowledge to practical use - uncomfortable asking the questions Lack Knowledge? - clinical relevance of material - missing some background information
19 The Learning Process TEACHER LEARNER CONTENT
20 Find the Lesion for Educators: Example: Teacher Learner Content Appears Bored Too longwinded? Monotone? Post-call? Just reviewed this with the CR? Distracted withsick pt? Life? Clinical relevance not clear? Background knowledge missing? Know it All Intimidating? Or tentative? Does not grasp what is truly relevant? Afraid to admit deficiency? Too basic?
21 2- Treat the Problem: The Therapeutic Trial
22 STEP 2 Treat the Problem: The Therapeutic Trial It usually takes more than one try Keep the focus on the behavior Keep your goal realistic
23 The Therapeutic Trial Treatment Options:
24 Principles of Motivational Interviewing (MI): Develop DISCREPANCY Avoid ARGUMENTATION Roll with RESISTANCE Express EMPATHY Support SELF-EFFICACY
25 Principles of Managing Interns: Develop DISCREPANCY Avoid ARGUMENTATION Roll with RESISTANCE Express EMPATHY Support SELF-EFFICACY
26 Diagnosis and Treatment Options: PROBLEM: Possible Dxs Possible Rxs:
27 STEP 3 Get a Consult: Other colleagues Program Director Clerkship Director
28 Stages of Change for the Reluctant Learner Pre-contemplation This is not important for good patient care I already know all I need to Contemplation There may bean easier way to deal with this kind of problem, but I am doing fine Determination There are some concrete skills that I can learn and use Mastering these skills will make me a better doctor
29 RECOVERY I understand the importance of this skill to good patient care I can do this Fatigue Burn out Personal issues Substance use RELAPSE
30 Take Home Points: Reluctance is in the eye of the beholder The same systematic approach and the same skills that work with challenging patients, work with challenging (reluctant) learners
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