This document provides guidance on addressing problems that can arise when teaching trainees and students in clinical practice. It recommends defining clear expectations and performance standards, regularly assessing the learner's self-evaluation, and using the "ABCD&Es" approach to handle issues. This involves carefully assessing problems, clarifying expectations, accurately diagnosing the underlying cause as a knowledge, skill, or behavioral issue, developing a mutual intervention plan, and evaluating its effectiveness. The document also discusses how to address attitudinal problems and offers confrontation techniques to keep issues small and resolved in a direct but non-personal manner. The overall goal is to implement a systematic approach to identifying and solving teaching-related problems.

1. Finding Solutions for
Problems Associated with
Clinical Teaching

2. Know
Do
Learning Objectives
• Some of the problems that can arise
when working with trainees and students
in clinical practice.
• Empowered to handle problems that arise in
your teaching practice.
• Develop specific strategies for assessing,
diagnosing, and responding to teaching-
related problems.
Feel

3. ① The expectations must be defined.
② The performance must be defined.
③ Any difference between performance
and expectation must be carefully
defined and analyzed.
Diagnose the Problem
Student’s Expectations vs. Student’s Performance

4. ABCD&Es of Handling Problems
Assess problem and concerns carefully. Ask the
student to self-assess.

5. ABCD&Es of Handling Problems
Assess problem and concerns carefully. Ask the student
for his/her own assessment.
Be direct in clarifying expectations, roles, and
responsibilities. Focus on behavior, which can be
changed.

6. ABCD&Es of Handling Problems
Assess problem and concerns carefully. Ask the
student for his/her own assessment.
Be direct in clarifying expectations, roles, and
responsibilities. Focus on behavior, which can be
changed.
Categorize/Diagnose problem as accurately as
possible—Knowledge? Skill? Behavior?

7. ABCD&Es of Handling Problems
Assess problem and concerns carefully. Ask the student
for his/her own assessment.
Be direct in clarifying expectations, roles, and
responsibilities. Focus on behavior, which can be
changed.
Categorize/Diagnose problem as accurately as
possible—Knowledge? Skill? Behavior?
Develop intervention/mutual action plan. Document
plan and follow-up.

8. ABCD&Es of Handling Problems
Assess problem and concerns carefully. Ask the student
for his/her own assessment.
Be direct in clarifying expectations, roles, and
responsibilities. Focus on behavior, which can be
changed.
Categorize/Diagnose problem as accurately as
possible—Knowledge? Skill? Behavior?
Develop intervention/mutual action plan. Document plan
and follow-up.
Evaluate effectiveness of intervention.

9. ABCDEs Guide
Assess the problem
– Is it real? Is it important?
Be direct
- How would you clarify expectations or
performance standards?
Categorize/Diagnose the problem
– knowledge, skill or behavior?
Develop an intervention or educational Rx:
– Education, relearning a skill, practice,
modeling and reviewing.
Evaluate effectiveness of intervention

10. Example #1 (Max)
A first-year resident is in your office in August.
He is eager to learn. When presenting cases the
first day, he moves from chief complaint to past
history to physical exam and back to history of
present illness. Some important information is
there, but it is presented in a disorganized way.
 Assess the problem
 Be direct in clarifying expectations or
performance standards
 Categorize/Diagnose the problem
 Develop an intervention or educational Rx

11. Example #2 (Lucy)
A third-year medical student is working with you in
October. She has seen an older patient who is
complaining of a headache. The student’s
differential diagnosis consists totally of AV
malformation and tumor.
 Assess the problem
 Be direct direct in clarifying expectations or
performance standards
 Categorize/Diagnose the problem
 Develop an intervention or educational Rx

12. Example #3 (Dawn)
A first-year medical resident is working in your office
in December. She has gone in to see one of your long-term
elderly patients with multiple medical problems who is
complaining of a cough. The resident returns after spending 45
minutes with the patient and admits that she has yet to do the
physical examination. You determine that the resident has the
necessary knowledge and skills but does not perform to
expectation.
PEP2 Facilitator’s Module 8 (Handling Problems), p. 8.16.
What is your next step?
- Do further analysis
- Develop a mutual action plan
- Document plan
- Evaluate effectiveness of intervention

13. Attitudinal Problems
Many times the problem is primarily one of
attitude…
 Does the student simply not buy into some of
the principles and approaches you stress?
 Does the student not value the experience with
you or does not see its relevance to his or her
future needs?

14. ConfrontationTechniques
① Identify and clarify differences.
② Directly, openly, and matter of factly, let the
person know when you’re confronting him
or her and why.
③ Diffuse anger by not taking it personally.

15. Example #4 (Eric)
A third-year medical student is spending the
month of May with you in your office. His histories
and physical exams are of reasonable quality, but
he shows little interest in obtaining or discussing
any psychosocial history. He says that he will take
call if required but would prefer to sleep.
How would you handle this attitudinal
problem?

16. 20
What challenges have you
experienced with
“Problem Learners” and what
solutions have you found?

17. Summary
① Share and clarify expectations at the start of the clinical
rotation.
② Ask the learner to regularly self-assess.
③ Communicate regularly with the learner and the program.
④ Use the “ABCs of Handling Problems.”
⑤ Apply “appropriate” confrontation strategies when needed.
⑥ Problems will still occur but having a systematic and timely
approach can help keep small problems small.

18. Implement the ABC’s in solving problems
associated with teaching learners in your
your clinical practice.

19. What will you keep the same?
What will you do more of?
What will you do less of?
What will you stop doing?
What will you do differently & how will you do it?
What will you add?
LEARN – REFLECT -TEACH