Teaching Tips & Tools - Other CanMEDS Strategies

Effective Management and Use of Time

AHS My Learning Link Courses: Alberta Health Services Offers a number of workshops through My Learning Link related to the roles and responsibilities of a healthcare professional.

Harvard Manage Mentor: Through the AHS Insite portal, learners have access to a number of online modules called the “Harvard Manage Mentor”. There are leadership and self-management focused modules, including Time Management and Organization.

Royal College Time Management Guide: The time management guide: A practical handbook for physicians by physicians is a workbook written by physicians for physicians addressing some typical time management issues. Learners should review and consider which worksheets and strategies might be helpful in addressing their challenges. They should then select 3-5 of these strategies to try and implement throughout their learning support period. Implementation should be progressive, building a habit around one strategy before trying another. Progress should be discussed with their coach or mentor.

Time-logging: The resident can be advised to maintain a time-log for a couple days or up to a week. The log can then be reviewed with the rotation preceptor in order to get a better understanding of where time is being lost and how to better balance/focus time. Alternatively, the learner can maintain a time-sheet of patient consults (i.e. tracking time spent with each consult) and obtain feedback around their patient encounters.

Task Categorization and Daily Planning: Have learner arrive to work early and use this extra time to make a plan for the day. List priorities in order of importance or in categories such as “must be done” or “if I have time”. Try to create a rough schedule for the day based on things that are more and less predictable. At the end of the day, once the necessary tasks are complete, the resident reviews how well they were able to follow the plan. Keep this in a log-book for review.

The Eisenhower Urgent/Important principle is a great way to help with the prioritization of daily tasks.

Junior to Senior Transition

Interview or Shadow a Mentor: The learner can select a number of preceptors to interview around their own experiences around transitions, collecting information around suggested strategies on managing increasing responsibilities. Alternatively, the learner can select a more senior person to shadow, with a focus on noting the added responsibilities in a senior role and strategies used by the person managing these responsibilities.

Progressive Responsibilities. Working with the Program Director or preceptor, a schedule of progressive responsibilities over the course of the rotation can be developed. The learner would receive direct support and guidance from a Senior/Mentor in performing select Senior responsibilities.

Progressive Entrustment: The learner can work through a series of progressive tasks or responsibilities using a progressive “entrustment” approach.  An entrustment scale allows for progressive “trust” to perform particular skills. As learners get comfortable taking on one responsibility, they can be given another to add until they are functioning comfortably as a senior.

The Daily Plan: A regular discussion with the preceptor at the beginning of each day regarding cases or case-types where resident will “take the lead” and assume full responsibility of the case.

Seeking and Accepting Feedback

Field Notes/Encounter Cards: Field notes are brief feedback documents. Field notes and encounter cards are a great way to put the onus on the resident in collecting regular feedback around areas of deficit. They are meant to be short and frequent. The learner would be responsible for collecting and collating the feedback, and discussing these with their coach, mentor, or Program Director during regular meetings.

Extension – Paraphrasing & Taking Action: Often learners can be passive in accepting feedback, they may hear it but not know what to do with it. It is helpful for a learner to paraphrase the feedback so there is a mutual understanding. Based on identified areas for improvement, the learner can discuss with the preceptor possible courses of action to correct the issue.

Setting Expectations: Learners should review in advance of each rotation the rotational objectives as well as the program’s overall objectives of training. They should discuss areas they need to work on with their preceptor at the start of each rotation or block. It is important to establish clear expectations, set clear goals, and have a good understanding of what success looks like for that rotation. Opening a channel of communication right from the start and disclosing difficulties is recommended and encouraged.

Foster Insight and Practicing Self-Reflection

CanMEDS Review: A reflective assignment where learners review the CanMEDS Milestones Framework and identify areas needing improvement in relation to ITER comments, other feedback, and remedial objectives. Learners are asked to submit a reflection on how concerning behaviors identified in ITERS impact colleagues and patients.

Regular Self-reflection/Journaling: Learning and personal growth are ongoing and continuous in the medical profession. Residents can be asked to maintaining a journal, setting weekly goals and reflecting on their achievements. These should be reviewed during regular follow-up meetings with the Program Director or coach.

ITER Review Assignment: Learner’s in difficulty should be asked to thoroughly review the content of past assessments (such as rotational ITERS), and to record all concerns and comments around areas of deficit. This review can help them identify how preceptors provide feedback and flag similar issues. Informed by this review, learners should propose some of their own learning objectives.

Self-Assessments: Have both the resident and preceptor complete the SAME assessment tool. Learners have a regularly scheduled conversation talking about discrepancies between the self-assessments and those of the preceptor. This has been effective in fostering insight and getting everyone on the same page.

Managing Job-Related Stress and Anxiety

HeartMath Biofeedback Intervention: Should learners be interested in learning how to use the breath to manage stress using the HeartMath approach, connect with the Education Support Specialist for access to an expert in this area who has developed a short program specific to remedial residents.

ePhysicanHealth: These are online Physican-focused Wellbeing and Stress Management Modules addressing a number of areas related to resident stress in the workplace.