Dr Connie Wiskin Professor John Skelton Ms Katharine Heathcock Interactive Studies Unit

1. Supporting Students in Professional Difficulty (Language, Attitude, Professionalism & Communication) Dr Connie Wiskin Professor John Skelton Ms Katharine Heathcock Interactive Studies Unit

2. The Interactive Studies Unit (ISU) • A multi-disciplinary team of 25 years’ standing, specialising in the teaching, testing and remediation of undergraduate and postgraduate healthcare professionals – language, character, professionalism, academic skills and management • Including intensive one on one support for doctors, other HCPs and students in difficulty; PSU • Audit of referral triggers for the latter will be presented today

3. What are you going to do to make sure you don’t graduate an unsuitable (or unsafe) doctor? Drawing on lessons, and a typology, from the well-established ‘Doctors in Difficulty’ (now re-named) Programme (16 years) a parallel programme for undergraduate students was developed. Support offered (individually) for problems identified with competencies that are not process/procedure (ie technical or knowledge-based). Referral routes via welfare system, year leads, FTP, teachers and – sometimes – self referral.

4. Doctors & Dentists in Difficulty • Suspension from practice for ‘poor performance’ (as opposed to ‘misconduct’) implemented 1997 • Referrals however more typically triggered by a progression hurdle (360 degree review, assessment failure, complaints, failure to thrive etc.) Up to 100 p/a

5. The Programme (UG & PG): • The problem is typically complex, multi-factorial, elusive and not simply ‘failure to master a clinical or communication skill’ • Separate from academic progress, a highly individualised one on one coaching support programme - where relevant involving a highly trained simulated patient or colleague. • Interventions range from 1-2 sessions to ongoing support over several years, but the focus is on periodic intensive sessions that the learners apply to the clinical environment Insight

6. Your Challenges?

7. Impactstudents may feel judged, stigmatised, unfairly treated, anxious, fearful, defensive, confused …. Some come to us with insight into their difficulties. Others do not. There is also an impact on you….

8. Why do they need support? Audit of triggers for student referral (see if this has resonance for you?).

9. Aim & Method Aim to establish a typology of referrals to inform future resource provision, and help (pre-emptively) identify problems at an early stage (tutor training). • A retrospective audit of 202 referrals over 7 years (and adding!). Triggers gleaned from referrer’s comments. Database SPSS v22, generated from pre-meeting referral letters.

10. Results 1: Who? Data removed as is original research in progress and not consented for public IT access. Please contact c.m.wiskin@bham.ac.uk if you wish for the information in a confidential manner.

11. Results 2: Quantitative • Data removed as is original research in progress and not consented for public IT access. Please contact c.m.wiskin@bham.ac.uk if you wish for the information in a confidential manner.

12. Results 3: Triggers

13. What do we do? Support and achievement

14. What we do • A question of ‘evidence’? • Initial one-on-one encounter • -Interactive, bespoke intervention(s), sometimes using high level simulation (role play) • - Report; observations, not opinion….

15. Note to the Referrer • Comments like “?? communication skills” and “lacks confidence” are not that helpful. Ask yourself; • What • Why • What next

16. Unhelpful: Birgitta poor with patients; needs communication/ exam practice. Helpful: Birgitta’s accented delivery means that sometimes patients find her hard to follow. This was reported in CBM & 2 OSCE stations. She seems to lack understanding of colloquial phrases, so tends to skim over them and make guesses without clarifying. Lacks confidence in unfamiliar situations. Anxiety exacerbated by observation and ‘judgement’. Would benefit from language support and coping strategies for the unfamiliar.

17. Values based approach • Core….Remediate knowledge, skills and values. • The fundamental issue is values. Knowledge and skills can be taught and tested by exams, and remediated by subject specialists (rather than people like the ISU). • Attitudes and values are key. Behaviour is much less important. • Finn, McLachlan etc. have published interesting work on the “Conscientiousness Index” (CI). I.e., if the student is e.g. late at seminars it’s a good sign they’re “unprofessional”. (Our referred doctors are frequently late).

18. “However (see This Bright Babylon J Skelton) – I invented a dialogue between Socrates and a pupil, agreeing that a doctor should not be late. But, says Socrates, I have a dog who always knows when it’s tea-time. Is my dog professional? No, because what matters isn’t the behaviour, it’s the intent to be professional (which the dog lacks) which underpins it”.

19. Cases • FTP • Exam failure • Self-referral • Diversity

20. NB This is NOT about coaching people to pass exams; • From Francis (Exec Summary). If all professional staff complied at all times with the ethics of their professions, there would have been no need for the plethora of organisations with commissioning and performance management responsibilities • I.e., engage people (students!) with the right values, and you don’t need to regulate them. • Look at the word “culture” in the Francis Report– it appears everywhere.

22. Conclusion, and recommendation • Struggling students infrequently have a “single” difficulty, which remediation processes need to acknowledge. • Communication with patients (where most courses focus) is not the main cause for concern. Teaching should address under-served areas. • Training for potential referrers to encourage earlier flagging (confidence and process) could help early intervention. • Exam failure and performance anxiety are frequently seen (but this is not about teaching students to pass) • Cumulative data ongoing from national pilots could identify significant trends related to student demographics.

23. Thank you (thoughts on future partnerships?) • Come and see us at COMET 2018! • C.m.wiskin@bham.ac.uk