Nursing Facility Performance in Assessing Residents Timely and
Assessing and Managing Residents in Difficulty
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Transcript of Assessing and Managing Residents in Difficulty
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Assessing and Managing Residents in Difficulty
Nancy Stevens, MD, MPHDepartment of Family MedicineUniversity of Washington
May 2013
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Residents in Difficulty, Not Difficult Residents Leaves open mind, more opportunities to
intervene Sometimes it is a program in difficulty Usually it is both
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Three Kinds of Difficulty Academic: faculty dx learning difficulty
behavior / attitude cognitive psychomotor
Disciplinary: due process usually breaking rules or laws
Impairment / Disability avoid temptation to diagnose
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Quick Quiz
Academic Disciplinary Disability
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Quick Quiz
Complaints from other residents about this resident’s disorganization and inadequate check out information
AcademicDisciplinaryDisability
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Quick Quiz
EHR flags resident reading family members chart
AcademicDisciplinaryDisability
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Quick Quiz
Resident uses marijuana legally at party Friday night, fails hospital required drug screen several days later
AcademicDisciplinaryDisability
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Quick Quiz
Entering resident asks for accommodation to facilitate treatment of bipolar disorder, has psychotic episode at work
AcademicDisciplinaryDisability
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Quick Quiz
Resident asks for accommodation for ADHD after 4 months of failing rotations for which she is on probation
AcademicDisciplinaryDisability
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Quick Quiz
Resident with very low scores on patient satisfaction
AcademicDisciplinaryDisability
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Quick Quiz
Resident refuses to provide care for patient whose behavior she finds morally objectionable
AcademicDisciplinaryDisability
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Quick Quiz
Military resident fails fitness standards
AcademicDisciplinaryDisability
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Quick Quiz
Resident avoids pelvic exams when indicated
AcademicDisciplinaryDisability
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Educating HR Disciplinary and Disability difficulties are
HR’s responsibility / the resident is an employee
Academic difficulties are the program’s responsibility / the resident is a student
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Faculty Roles Conversation / consensus about
expectations before a calamity Resident education about the process in
advance Structure reduces wasted time / angst
/splitting
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Improve PerformanceAvoid Problems
Coach(Advisor or selected for difficulty)
League Manager(Program Director or DIO)
Cheerleader(Faculty or staff with professional distance)
Referee(Standing group or specifically appointed)
Intimate Knowledge of Difficulty
Distant From Difficulty
Faculty Roles
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Challenges for FM Educators We prefer to be the coach or cheerleader Focused on growth potential Suspicious of faceless discipline Relationships tempt us to side with
residents Vulnerable to splitting
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Prerogatives: Drawing the Line When a problem arises, who controls
whether it gets resolved, the resident or the program?
What about when there is uncertainty?
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Quick Quiz
Resident prerogative Program prerogative Work-up
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Quick Quiz
Resident has 60 incomplete charts during a period of regular work schedule.
Resident prerogativeProgram prerogativeWork-up
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Quick Quiz
One faculty member finds a resident’s appearance unprofessional but there is no faculty consensus about this.
Resident prerogativeProgram prerogativeWork-up
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Quick Quiz
Clinic staff concerned a resident is consistently late to clinic
Resident prerogativeProgram prerogativeWork-up
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Quick Quiz
A resident quietly texts during presentations by others
Resident prerogativeProgram prerogativeWork-up
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Quick Quiz
R3 has O attendance for the first 3 months of didactics, says she is “so done with that”
Resident prerogativeProgram prerogativeWork-up
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Quick Quiz
A OB faculty passes you in the stairwell an raises his concern about a resident with poor procedural skills who responds to feedback with little insight about it.
Resident prerogativeProgram prerogativeWork-up
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Routine Resident Evaluation
Concerns?
RESIDENT PREROGATIVE / WORKUP CYCLE
Program intervention
Justified?ConcernsRemain?
Gather informationon differences
inPerceptions? Values?
Provide Assistance
Hypothesize and Focus Problems AgreeNo Agree
PROGRAM/FACULTY PREROGATIVE
Monitor performance, Make recommendations
Take administrativeaction
yes
no
yes
yes
nono
1 23
4 5
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Thank you!