EVERY PROGRAM NEEDS TO HAVE A FRAMEWORK FOR IDENTIFICATION OF LEARNERS WHO IN NEED OF INTERVENTION. INTERVENTION IS THE STEP BEFORE REMEDIATION.

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This framework should include:

  • Guidelines for Early Identification
  • Identification of Early vs Late Identifiers
  • Faculty Development
  • And recognize possible barriers to an effective intervention

Guidelines for early identification

There are several elements to keep in mind during the initial phase of struggling learner identification. The underlying concept here is that this is a time of learner support. Stressing with the new house staff that you want to know if there are issues that they are having, that you want to hear about them is essential.

If they come to you early on, you will be able to tell, with experience, which concerns or issues are elements of “getting used to residency/fellowship” and which are issues are those that might need more support.

In addition, beginning of training needs to be a focused observation time for all learners – once again, the earlier you catch these deficits, the easier they are to provide educational intervention for.

Some strategies for this early period re

  • Inform your new learners that you want to know what is going on with each of them.
  • Meet with them one-on-one (PD or advisor) early in training to check-in.

These two actions will start to establish a trust relationship so that learners will be comfortable coming to you when they are starting to struggle instead of hiding their issues.

Another strategy is to have at least one faculty review meeting in the first few months of residency that focuses solely on interns and transfers or first year fellows. Repeatedly stress with faculty that the observations and evaluations in the first few months of training are maybe the most important of the entire training time.

Identifying early vs late identifiers

Let’s discuss early and late identifiers

Some early identifiers of potential problems are:

  • Verbal comments by faculty, chiefs, residents, nurses, and other ancillary staff
  • A report in writing (perhaps an on the fly evaluations) on email
  • Notification of a critical incident or patient safety alert involving this trainee
  • Mid-rotation clinical performance evaluations or noting issues during a simulation, OSCEs, CEX or mini-CEX

All of these are considered early identifiers as they happen in real time and are often brought to the attention of the PD or APD in a timely basis.

Then there are the late identifiers, these include:

  • In-house written examinations
  • Peer or multisource assessments
  • End of rotation performance evaluations
  • Comments during a faculty review of trainee performance
  • Or perhaps, an unsatisfactory In training exam performance

All of these identifiers, which are the mainstay in most programs for alerting to a possible issues, are actually quite late in the process. If you can focus on the early identifiers, you will be more successful in intervening and directing your learners back to where they need to be.

 

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