The Resident in Difficulty

In what areas can a learner be deficient?

There are several areas in which a learner may be deficient. Some of these deficiencies may be easily dealt with while others will need help from the University faculty. Below is a list of possible problem domains. The learner's difficulty may manifest itself in several different behaviours.    

• Deficiency in knowledge- Clinical judgment difficulty, poor knowledge base, or premature closure of inquiry.
• Deficiency in skill- Poor interviewing skills or poor physical examination techniques.
• Attitude problems- Overconfident, over-involved with patients, lazy, psychiatric problems, lying or substance abuse.

What are some possible interventions?

The intervention applied will be different in each case, tailored to the specific resident in question. The resident's program director is an invaluable tool in helping to plan an appropriate intervention. You may also want to look at other resources to help such as the Internet or educational materials.

Discuss the problem with the learner as soon as it is apparent to you. Don't wait until the end of the rotation and give a failing grade; this isn't fair to the learner and doesn't allow time for remediatio n.

Sample Problems                                   

• Poor knowledge base
• Develop a learning plan with more teaching time.   Ensure that adequate materials such as books/internet resources are available. Set the learner a daily educational task and allow some time to receive a report on the issues raised the day before. Require the learner to present rounds to you and your colleages once a week on relevant topics
• Poor Clinical Judgment
• Develop a learning plan that involves assisting the learner with weighing clinical evidence, ranking common disorders and doing a proper differential diagnosis
• Slow Worker            
• Determine where the delays are occurring.   The most common delays include lack of knowledge of the office routine, lengthy patient explanations, too much history taking (not focused). Tailor your plan to meet the learner's weak areas. Set a time limit for each patient encounter
• Argumentative with Preceptor

Determine what the problem is. Is there a problem at home? Is the argumentative nature a defense mechanism? Sit down and discuss the resident's feelings. Do not attack the learner. If you can determine the cause, discuss with the learner a plan.

Who do I contact for help?

The first person to contact is the resident's faculty advisor or unit/program director. They are there to help both you and the resident.   The program coordinators are invaluable in pointing you to the right person.

Dr Fred Janke
Unit Director, Rural Alberta North
Phone: 1-866-444-6353
Email: fred.janke@arfmn.ab.ca

Dr. Peter Koegler
Unit Director, Rural Alberta South
Phone: 1-866-382-1666
Email: peter.koegler@arfmn.ab.ca

Dr. Hugh Hindle
Rural Academic Development Coordinator
Phone: (403) 887-2259
Email: hugh.hindle@arfmn.ab.ca

1 Rubenstein W, Talbot Y. Medical Teaching in Ambulatory Care 2 nd ed . 2003. Springer publishing USA