Transcript PPTX - Uniformed Services University of the Health Sciences

Resident – Faculty Advisor &
Mentorship Systems
Brian V. Reamy, MD
Colonel(ret),USAF,MC
Associate Dean for Faculty
Professor of Family Medicine
Uniformed Services University
Introduction/Objectives
• Identify the different types of resident –
faculty advisor & mentorship systems
• Explain the key developmental tasks of
residents in training
• Identify positive and negative qualities in
faculty advisors
• Describe the features of an “optimum”
resident-faculty advisor system
Historical Context - 1982
• Borus & Groves: “Training Supervision as a Separate Faculty
Role” Am J Psychiatry 1982;139(10):1339-42.
Historical Context
• “Training supervision is a longitudinal,
nonclinically focused personal relationship
between a faculty member and a resident for
exploring the latter’s professional development.
They … meet monthly over the 3-year residency.”
• “The training supervisor’s role is that of a nonevaluative senior colleague who orients and
advises the resident and systematically reviews
training progress and problems”
Who has a resident-faculty advisor
system?
- How is it structured?
- Who assigns residents?
- Who makes changes
when problems emerge?
-Is it based on advising
and evaluation or just
advising?
Types of Advisor Systems
• Based on Clinical Care Teams
• Self-selection
• Proportional to faculty numbers
– Random assignment
– Assigned by PG year group
• One faculty for each PG year group
– Stay with year group thru residency program
– Stay with their specific PG year group
Types: Clinical Care Teams
•
•
•
•
Most common system
Example: 3 year PEDS Residency
6-6-6 resident structure
6 faculty + 1 PD + 1 Dept Chair
– Faculty physician + PG-3 + PG-2 + PG-1= care team
– They cover each others patients during TDY’s/LV
– This is also the academic advisor group
Types: Self-Selection
• Residents are told to select their advisor
within 3 months of arrival
– Can not select the PD
– Rare in M.D. training
– Common in Ph.D. programs
Types: Proportional
• If you have 24 residents and 8 faculty then
each faculty member will get 3 advisees
– Random/lottery or,
– Each faculty takes one resident from each PGY or,
– Assigned by PD based on research or clinical
interests, gender, request etc.
Types: Assigned to PG year groups
•
•
•
•
•
Example: 3 year Internal Medicine Program
8-8-8 resident complement; 16 faculty
One faculty (LTC Bezoar) has ALL PGY-1
One has ALL PGY-2…one has all PGY-3
2 variations:
– LTC Bezoar stays with his year group x 3 years or,
– LTC Bezoar is always the PG-1 faculty advisor
Advantages/Disadvantages
TYPE
ADVANTAGES
DISADVANTAGES
Clinical Care Teams
Faculty learn more about
resident’s clinical practice
TDY’s & deployments can
make advising difficult
Self-selection
Potential for better
relationships
Some residents never
actually choose…
Proportional/random
Perception of fairness
enhanced
May end up w/ some
dysfunctional pairings
1 Faculty/PGY – follows
residents thru program
Faculty REALLY knows the
residents & can facilitate
improvements
Big faculty workload.
Residents are “stuck” with
the same faculty for length
of training
1 Faculty/PGY - yr. specific
The faculty REALLY knows
the issues each specific
year group faces and
knows better how to
problem-solve
Big faculty workload.
Key Issues w/each system
• Who does OER’s/OPR’s/FitReps?
– Evaluation sabotages advising & mentoring!! It must
exist – but, separate from the advisor system.
Many cites: Davis OC, Nakamura J. A proposed model for an optimal
mentoring environment for medical residents: a literature review. Acad
Med. 2010;85:1060-1066
Sambunjak D et al. What makes a good mentor-mentee relationship? JCOM.
2010;17:152-154
• Distributing Faculty workload
• Who manages change requests?
– Chief resident? Prog Dir?
Key Issues
• Who gives out discipline?
– Should not be the advisor
– Advisor should always wear a “white hat”
– The Prog Director or Dept Chair should wear the
“black hat”
Key Developmental Tasks of Residents
in Training
• Martin & O’Donnell. Resident Developmental Issues. Fam Med
1999;31:614-615.
• 10 Common Developmental Issues for Faculty
advisors to facilitate
10 Developmental Issues
ISSUE
1
Do not assume all residents progress at the same pace
2
Be available to residents to listen to and explore their concerns
3
Model a balanced life
4
Be willing to be vulnerable and share how you learned from your mistakes
5
Model flexibility in the face of chaos and model how you deal w/ uncertainty
6
Promote paced change and continuous growth
7
Give positive feedback
8
Help residents move towards independence & life after residency training ends
9
Be patient with growth and changes
10
Set boundaries
Advisor/Mentor Qualities
• We have all experienced good & bad faculty
advisors and mentors?
– You can get better at this!
– Many of the skills are those that serve you well in
your clinical work with patients.
– Reference: Sambunjak D et al. A Systematic Review of Qualitative
Research on the Meaning and Characteristics of Mentoring in
Academic Medicine. J Gen Intern Med. 2009;25:72-78.
Positive Qualities in a Faculty Advisor
?
?
Positive Qualities in a Faculty Advisor
Most Important (literature support)
Other positive qualities
ADVOCATE
Competent
MENTOR
Sounding Board
PLANS IMPROVEMENT
“Bitch & Moan Sponge”
DELIVERS HONEST FEEDBACK
Nurturing
EXPERIENCED
Reality Check
AVAILABLE
Aware
APPROACHABLE
Doer
INSIGHTFUL
Fair
GOOD LISTENER
Dedicated
PROMOTES RESPECT
Resourceful
ROLE MODEL
Social Director
Negative Qualities
Qualities to Avoid
Social Director
Disciplinarian
Plays Favorites
Unavailable
Overextended
Inconsistent
Intimidating
Cynical & Jaded
Evaluator & Rater
Optimum System
• Six core interactional
foundations
1)
2)
3)
4)
5)
6)
Emotional safety
Responsiveness
Support
Protégé-centeredness
Respect
Informality
How would an optimum system
appear?
• Evaluation is NOT confused with advising &
mentoring
• Advisors who embrace the positive qualities
• Equal distribution of faculty workload
• Resident buy-in
• Structure
– Fits w/ your institution & training environment
– Thoughtfully selected
Optimum System
• Meeting Frequency & Guidelines
– Informal “chats”: at least monthly
– Formal faculty:advisee meetings every 3-4 mths
– Need pre-planning ( initial vs. follow-up mtgs.)
– Advisors need to get FULL faculty input
– Avoid gossip sessions
– Faculty need to keep records
Records
• Without records a faculty forgets or confuses
• Confusion sabotages the faculty-advisee
relationship
• Focus of the records is fourfold:
– Includes review of rotations & areas of concern
– Includes faculty expectations & resident goals
– Includes a Resident summative self-assessment
– Ends with an Educational Rx
ADVISEMENT RECORD EXAMPLE
Name:
Date:
RESIDENT ADVISEMENT
ROTATIONS:
(1)
(2)
(3)
(4)
AREAS OF CONSIDERATION
Comments regarding above topics:
CONCERNS
YES/NO
NOT
REVIEWED
CONCERNS
YES/NO
1 . Conference
Attendance
9. In-Training Exam
2. Time Management
3. Relationships
with Colleagues
10. Licensing
1 1. Research Project
4.
Family/Personal
Adjustment
5. Life Balance
6. Procedures
7. Chart Reviews
12. PME/Officership
8. Core Competencies
16. Teaching/Supervision
13. TDY Interests
14. AHLTA/Coding
15. Reading/Study
NOT
REVIEWED
FACULTY EXPECTATIONS
RESIDENT GOALS ____________
RESIDENT SELF-EVALUATION:
Unsatisfactory
Marqinal
Performance
fails to meet
standards of
acceptance.
Rehabilitation
is doubtful.
Lacks
motivation,
interest, and
performance
is limited.
Cannot
continue
without
substantial
improvement.
Below
Average
May continue
in program,
but
performance
is below
standards.
Effective and
Competent
Satisfactorily
meets the
stated
objectives.
Verv Fine
A continuing
level of high
performance
in most
aspects of
stated
objectives.
Exceptionally
Fine
Performs
outstandingly
in most
aspects of
job. Initiative,
leadership
and
personality
are worthy of
special
notice.
Outstanding
Extremely
rare,
Excels in
everything.
Performs far
beyond level
of training.
Educational Rx:
Advisor & Resident Signatures
Potential Quicksand
•
•
•
•
•
•
Social
Friendship
Being a Clinician for advisee
Acting as a disciplinarian
Not involving the PD
Not proactively making time for meetings
Take Home Points
• 5 primary structures of faculty-resident advisor
systems exist and you should thoughtfully select one.
• Evaluation sabotages advising & mentoring!! It must
exist – but, separate from the advisor system.
• All residents work through 10 major developmental
tasks at their own individual pace.
• There are advisor qualities to emulate and those to
avoid. You can improve your skills as an advisor.
• An optimum system can be designed and put in place
Thanks & Questions