Failure to Fail ‑ Why or Why Not?

• DUTY to the public – DUTY to the learner
• Patient safety
• Reputation of the profession
• Learners who have difficulty in medical school are more likely to have formal complaints against them as practitioners
• Increased level of professionalism issues during and post medical training (in practice)
• Credibility of educational standards and institutional integrity

• Time
• How will this impact the learners future career?
• Second guessing what you are observing (is it just me, are they just having a bad day?)
• Unsure how to begin the process or conversation with a learner
• What does this mean for me as teacher?
• Will I be supported as teacher?

Caution! Signs that there may be trouble ahead for a learner

• Can’t focus or prioritize
• Poor fundamental of knowledge
• Overeager or excessive shyness
• Poor knowledge integration and consolidation
• Lack of professionalism
• Deficits in communication skills
• Failure to improve with feedback

Five Remedial Roles:

• Facilitator - enthusiastic, motivation
• Nurturing mentor - approachable
• Disciplinarian - honest, enforcing
• Diagnostician - observation and thought
• Role model - accountable, professional

• Observe your learner
• Has the behaviour or action(s) of concern been repetitive?
• Attempt to engage the learner if they appear disengaged or unfocused
• Suggest a private conversation and gauge their interest in feedback:
  • Learner may be able to provide insight and explain recent actions
  • Learner may not be receptive to your feedback and observations
  • Learner may be relieved to receive feedback and seek assistance

DOCUMENT, DOCUMENT, DOCUMENT!

If it is not documented, it NEVER HAPPENED!

• Ask to meet with the student at an agreeable time and private meeting space
• Sensitive and timely feedback is sometimes sufficient
• Don’t sugar-coat the problem
• Establish and reassure the goal is learner success
• State plainly “I am giving you feedback” (this provides context and confirms feedback is occurring)
• Provide the student opportunity to share their perception of the issue
• Ensure there is documentation of your observations and conversations with the learner

• Set the tone – Allow a few minutes and open-ended questions as to how they see them selves and their progress
• Review assessment document with your learner (and co tutor for Professional Competency units)
• Refer to notes you took at weekly tutorial sessions related to learner’s performance

DOCUMENT, DOCUMENT, DOCUMENT

• Learners’ perception of participation may be different than yours as Teacher:
  • Encourage the quieter, reassure them their knowledge is wanted
  • Remind the strong in leadership learner to allow opportunity for all voices
• Cleary state areas where learner has met or exceeded learning outcomes
• Clearly state issue(s) of concern
• Confirm learner has understood and heard your feedback
• Re visit how they see them selves and provide opportunity for learner to share thoughts

Review and reflect upon a learner you have encountered that you were concerned about meeting learning outcomes and expectations.

Think about:

• Your duty as teacher.
• How might this impact the learner’s future medical education?
• Will patient safety be of concern?
• What steps did you / could you have taken to identify areas of concern with this learner?

Learner in difficulty: Change in practice

Upon review of some best practices and why or why not to fail a learner:

1. Think about what practices you will continue doing should you be required to offer feedback to a learner in difficulty?
2. Consider what change(s) in practice you will implement to help provide better prepare for a conversation with a learner in difficulty. (Hint… document, document, document)