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Resident as role model: Capitalizing on a powerful opportunity

Helping residents become more aware and deliberate role models is an important part of the CanMEDS 2015 Framework and essential to creating positive learning experiences for those whom they teach.

The Royal College is offering all programs a simple and accessible online learning module for facilitators to provide valuable role modelling training to residents in a single academic half-day (approximately two hours). All you need is the material below and a facilitator to help guide the residents through the process:

As a program director, you are undoubtedly aware of the important role residents play as teachers. In fact, studies have shown that residents spend up to 25 per cent of their time in residency engaging in teaching. Furthermore, medical students report that the single most important way that residents teach them is through role modelling.

Teaching role modelling, however, is no simple task. In fact, while “Resident-as-Teacher” curricula have become commonplace in virtually all Canadian residency programs, they typically do not include sessions that focus on helping residents become more effective role models. Now training is just a click away!

This workshop was developed at McGill University by: Dr. Robert Sternszus, Dr. Yvonne Steinert, Dr. Farhan Bhanji, Dr. Sero Andonian, Dr. Linda Snell.

The authors would like to thank: Jerry M Maniate, BSc, MD, MEd, FRCPC, University of Ottawa and Geoff Williams, MD, FRCPC, Dalhousie University for assisting with the trial runs of the workshop at their respective institutions.

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Start here with our Facilitator Guide

Download [PDF]

This role modelling workshop is intended to last approximately two hours and is built in a flipped classroom format (if you are unfamiliar with the concept, view a short video about the flipped classroom here). It will consist of an online module to be completed by residents prior to the workshop, participating in a large group discussion, engaging in simulations/role-plays and reflecting in a large group debriefing session. All of the materials that you will need to run the workshop are provided. Should you wish to do some additional reading on the topic prior to the workshop, some key references have been provided in Appendix A.

The workshop can be run at any time and has been designed to fit in to an academic half day. The content is appropriate for residents of any stage; however, if your institution has stage specific half days, is best suited for more senior residents (core stage). All residents have role modelling experience, most are simply not aware of it, and that is a key message of this workshop. The workshop can be run with groups of any size – if you choose to run simulations rather than role plays, it is simply a matter of ensuring you have enough space/rooms and the appropriate number of standardized patients.

The following is a suggested template for how you may choose to run the workshop (template PowerPoint also included to help guide the workshop).

Prior to the workshop

One week before to the workshop, send participants a link to the online module with instructions to complete prior to the workshop. The short online module provides participants with all of the required background knowledge on resident role modelling that they will need to participate in the experiential components of the workshop.

(OPTIONAL) Send participants the pre-workshop questionnaire. You can send this as a Word document (Appendix B) or build the survey in the online platform of your choice. This survey is optional, but is recommended if you’d like more information about your participant’s prior knowledge of and experience with role modelling. Note: If you choose to use the pre-workshop questionnaire, ensure it is sent prior to sending the emodule link as their answers will be influenced by the emodule content.

The workshop

Round table introduction (fifteen minutes)

Each resident shares one thing they hope to learn from the workshop.

Video reflection/Large group discussion (twenty minutes)

Within the online module, participants were asked to view the video and reflect on the provided questions. You may choose to show the clip again (click here to view the video), or to jump directly into the discussion. The clip depicts both positive and negative role modelling and is intended to help participants apply what they learned in the online module. Ask participants to retrieve their answers to the questions below (they were asked to complete these questions in the online module) and discuss as a group. Possible responses can include, but are not limited to, the following:

  1. What is something positive that is being role modeled by the resident/attending staff?
    1. Resident:
      • Sitting down when talking to the patient
      • Physically bringing Mrs. Rice to make the follow-up appointment so that she feels more secure
      • Acknowledging his error in the initial interaction with Mrs. Rice
    2. Attending staff:
      • Listening to the medical student and validating his opinion
      • Acknowledging his error in the initial interaction with Mrs. Rice

  2. What is something negative that is being role modeled by the resident/attending staff?
    1. Resident:
      • Looking at his watch during the interaction
      • Not allowing Mrs. Rice enough time to express her concerns
      • Not recognizing or responding to Mrs. Rice’s distress
    2. Attending staff:
      • Not recognizing or responding to Mrs. Rice’s distress

  3. What ‘key actions’ for effective role modelling are demonstrated in this video?
    1. Resident:
      • Focusing the medical student on what to observe in the second interaction with Mrs. Rice and offers an opportunity to discuss afterwards
    2. Attending staff:
      • Debriefing the interaction with the team
      • Observing the resident and providing feedback
      • Reinforcing key learning points (e.g., ‘taking an extra five minutes can go a long way’; the importance of close follow-up)

  4. What additional ‘key actions’ could have been used to make the role modelling more effective?
    1. Resident:
      • Demonstrating more initial awareness of being a role model
      • Focusing the student on what to observe in the first interaction with Mrs. Rice
      • Offering the student an opportunity to lead the discussion with a patient and receive feedback
    2. Attending staff:
      • Demonstrating more initial awareness of being a role model
      • Discussing with the resident the important aspects of breaking bad news prior to entering to see Mrs. Rice.

Simulations/role plays (sixty minutes depending on the set-up and fidelity)

Please see Appendix C (Scenario 1: Dealing with a difficult inter-professional interaction) and Appendix D (Scenario 2: Lifestyle counselling) for the detailed simulation/role playing scenarios that can be adapted to your context. Prior to beginning these scenarios, show residents the slide on the ‘seven key actions’ for effective role modelling. These actions will be the focus of the simulations.

We suggest that each scenario include:

Large group concluding debrief (fifteen to twenty minutes)

Round table discussion where each resident highlights one thing that they learnt from the workshop that they will apply the next time they are working with a medical student or a junior resident.

Post-workshop questionnaire (five minutes)

Send participants the link to the post-workshop questionnaire.

Note: Should you wish to receive a copy of the results, please email us at canmeds@royalcollege.ca

Closing (five minutes)

Remind participants that you’ll be sending a link to the retrospective pre-post questionnaire in one month.

Note: Should you wish to receive a copy of the results, please email us at canmeds@royalcollege.ca

(OPTIONAL): You may also send participants a link to the Direct Observation of Resident Role Modelling (DORRM) rubric. This assessment tool is intended to provide formative feedback and assist in the assessment of the role modelling of residents. It also provides valuable input on the impact of the workshop. Encourage participants to share this with at least one clinician who will rate them on at least one role modelling interaction. Please note: This tool was designed to assess the various actions highlighted in the workshop; however, it has not been systematically used or validated.

Facilitator post-workshop survey (five minutes)

We want your input on the workshop to help us continue to make improvements! Please take a few moments to share your thoughts at the following link.


Appendices

Appendix A

Reading list for residents and facilitators [PDF]


Appendix B

Pre-workshop questionnaire [DOC]


Appendix C

Scenario 1: Dealing with a difficult inter-professional interaction [PDF]

GENERAL
  • Simulation focus: Role modelling difficult inter-professional interactions
  • Simulation duration: ten minutes
  • Simulation objective: Demonstrating positive professional behaviors while using strategies for effective role modelling
  • Setting: Inpatient hospital ward conference room
  • Physical exam: None
  • Number of standardized patients: two (medical student role and nurse role)
EXPECTATIONS OF THE CANDIDATE

The participant should:

  • Be aware of themselves as a role model in this situation
  • Focus the learner on how they are going to approach the situation with the nurse and what to watch for
  • Demonstrate positive personal and professional behaviour in their interaction with the nurse
  • Reinforce what they have demonstrated to the learner
  • Help the learner reflect on what they have demonstrated
  • Offer the learner an opportunity to observe them deal with a similar situation should it arise again
SUGGESTED QUESTIONS FOR DEBRIEFING AFTER THE SCENARIO IS COMPLETE
  1. Were you a role model in this situation? For whom?
  2. Were you aware that you were role modelling in this situation?
  3. What did you role model?
  4. How did you role model it?
    1. Did the student learn from you? How do you know?
    2. What did you do to help them learn?
  5. What could you have done to make your role modelling more effective?

** The debrief needs to be focused not on how the resident handled the conflict but rather, how they taught the student about managing inter-professional conflict through modelling. This will likely requiring a lot of redirecting.

GENERAL
  • Simulation focus: Role modelling difficult inter-professional interactions
  • Simulation duration: ten minutes
  • Simulation objective: Demonstrating positive professional behaviors while using strategies for effective role modelling
  • Physical exam: None
  • Number of standardized patients: two (medical student role and nurse role)
SETTING

Inpatient hospital ward, conference room

OBJECTIVE

Help a medical student learn how to deal with a difficult inter-professional interaction through role modelling (showing).

SCENARIO

You are the senior resident on an inpatient hospital ward. One of your medical students (John) just paged you because a nurse was quite upset about the management of one of his patients. The student is waiting to meet you in the conference room. You have asked the unit coordinator to have the nurse meet you in the conference room to discuss the situation when she is available.

TIME LIMIT

Ten minutes

You will have two minutes alone with the medical student before the nurse enters and the nurse will exit two minutes before the end of the scenario.

CHARACTERISTICS OF THE MEDICAL STUDENT
  • Name: John Dorion
  • Age: 25
  • Gender: Male
  • Language: English
  • Notable physical characteristics: None
  • Clothing: Buttoned up shirt, lab coat, stethoscope
  • Marital status: Single
  • Children: None
  • Occupation: Junior medical student
  • Education: Medical school
  • Socioeconomic status: Middle class
  • Attitude to candidate and nurse: Uncomfortable, timid
  • Opening statement: “Thanks for coming. Let me tell you what’s going on.”
  • Closing statement: “Thanks again for helping me with this.”

Presentation:

  • Body language: Uncomfortable
  • Affect: Anxious but eager to learn
  • Appearance: Anxious
  • Info given spontaneously: The medical student describes the patient situation (adapt to your specialty). The patient is very sick and the nurses are worried about their ability to manage the patient on the inpatient floor. They were upset with the student’s response to this concern. [Example from pediatrics: The patient is Jason, a one month old boy with bronchiolitis. The nurse got very upset with the student when he told her that the baby needs to be suctioned every hour so that he doesn’t choke on his secretions. She said she doesn’t have time to babysit the patient.]
  • Information given when prompted: The student didn’t know how to handle the situation and simply walked away without saying anything. He is very anxious and feels uncomfortable talking to the nurse.
OPENING SCENARIO FOR THE STUDENT

Background: You are a junior medical student on an inpatient ward. One of your patients is [adapt to your specialty as above]. After rounding with the team in the morning, you asked your patient’s nurse [adapt to specialty] (this was the advice of the attending physician). The nurse became very upset with you, proclaiming that she doesn’t have time to provide that kind of care to one patient. You have called your senior resident (candidate) to help with the situation. He is to meet you in the conference room, and the nurse is to come shortly after. Before the nurse arrives, you will explain what happened with the nurse and ask for the residents’ help in dealing with the situation. You feel very anxious and uncomfortable, but eager to learn. You will observe the interaction between the resident/candidate and the nurse once she arrives. When the nurse exits the room (with two minutes left in the scenario), you will thank the resident for helping you and open the door for him/her to discuss/debrief the interaction with you in the remaining time.

Additional notes on attitudes, concerns, expectations: You are anxious about the situation and unsure of what to do. At the same time you are eager to learn from the resident.

CHARACTERISTICS OF THE NURSE
  • Name: Carla Turkleton
  • Age: 32
  • Gender: Female
  • Language: English
  • Notable physical characteristics: None
  • Clothing: Scrubs
  • Marital status: Married
  • Children: One
  • Occupation: Nurse
  • Education: Bachelors of nursing
  • Socioeconomic status: Middle class
  • Attitude to candidate and student: Overwhelmed and frustrated but willing to collaborate if she feels that her concerns are being heard
  • Opening statement: “What can I do for you?”
  • Closing statement: “I have to get back. I have lots of patients to see.”

Presentation:

  • Body language: Busy/tired
  • Affect: Frustrated/overwhelmed
  • Appearance: Tired and frustrated
  • Info given spontaneously: The nurse feels it is unreasonable to ask her to do what the student has asked her to do. She is worried about the safety of the patient. [Pediatrics example: She feels it is unreasonable to ask her to suction the baby every hour. She has other patients to look after too. She feels that if the baby needs this much care that he should be in the ICU. She is worried he’s going to deteriorate.]
  • Information given when prompted: There was a sick call by another nurse and she is already taking care of two extra patients in addition to her usual four and the acuity on the unit is higher than usual. In addition, the nurse had a similar patient recently and it did not go very well. She is very worried about the wellbeing of the patient.
OPENING SCENARIO FOR THE NURSE (arrives at two minutes)

Background: You enter the room to discuss with the medical team. You feel that the request of the medical student was unreasonable as you have other patients to look after, one of which is also very sick [adapt to specialty]. There was a sick call and you are already taking care of 2 extra patients and are overwhelmed. If the candidate asks about your concerns, you will also tell him/her that you are anxious because your last patient with similar issues ended up with complications and you feel the situation is unsafe. You don’t feel you can keep up with the care the patient needs and are very worried about his wellbeing.

Additional notes on attitudes, concerns, expectations: You will remain frustrated until the candidate acknowledges your concerns and engages you in coming up with a solution to make sure the patient is well cared for. If you feel that your concerns are being heard, you become more collaborative. Possible solutions are giving one of your other patients to a nurse with more stable patients, consulting a service, reviewing with the attending, etc.). You will exit the scenario after six minutes (eight minutes into the scenario) by saying that you need to return to your patients.


Appendix D

Scenario 2: Lifestyle counselling [PDF]

*Generally applicable to most specialties. May require a slight modification*

GENERAL
  • Simulation focus: Role modelling how to deliver effective lifestyle counselling
  • Simulation duration: ten minutes
  • Simulation objective: Demonstrating positive professional behaviors while using strategies for effective role modelling
  • Setting: Family medicine clinic
  • Physical exam: None
  • Number of standardized patients: two (patient and junior resident)
EXPECTATIONS OF THE CANDIDATE

The participant should:

  • Be aware of themselves as a role model in this situation
  • Focus the learner on how they are going to approach the situation with the patient and what to watch for
  • Demonstrate positive personal and professional behaviour in their interaction with the patient
  • Reinforce what they have demonstrated to the learner
  • Help the learner reflect on what they have demonstrated
  • Offer the learner an opportunity to observe them deal with a similar situation should it arise again
SUGGESTED QUESTIONS FOR DEBRIEFING AFTER THE SCENARIO IS COMPLETE
  1. Were you a role model in this situation? For whom?
  2. Were you aware that you were role modelling in this situation?
  3. What did you role model?
  4. How did you role model it?
    1. Did the student learn from you? How do you know?
    2. What did you do to help them learn?
  5. What could you have done to make your role modelling more effective?
GENERAL
  • Simulation focus: Role modelling how to deliver effective lifestyle counselling
  • Simulation duration: ten minutes
  • Simulation objective: Demonstrating positive professional behaviors while using strategies for effective role modelling
  • Physical exam: None
  • Number of standardized patients: two (patient and junior resident)
SETTING

Family medicine clinic, patient sitting at the desk

OBJECTIVE

Help a junior resident learn how to give effective lifestyle counselling through role modelling (observing them/intervening when necessary/providing feedback).

SCENARIO

You are a senior resident supervising a junior resident (Lisa) in clinic. Lisa has just reviewed the case of Mr. Jackson, a 45-year-old obese male presenting for [specialty specific example: consultation for hip surgery; routine visit; cardiovascular assessment], with you. He is a salesman who has unhealthy eating and exercise habits, but has an otherwise unremarkable general medical history and physical exam. You will now accompany Lisa to see Mr. Jackson, in order to observe and help her deliver lifestyle counselling. You are permitted to step in if and when it is needed. You will have two minutes at the end of the scenario to discuss the encounter with your junior resident.

TIME LIMIT

Ten minutes

CHARACTERISTICS OF THE PATIENT
  • Name: Mr. Jackson
  • Age: 45
  • Gender: Male
  • Language: English
  • Notable physical characteristics: Overweight
  • Clothing: Street clothes
  • Marital status: Married
  • Children: Two
  • Occupation: Salesman
  • Education: College
  • Socioeconomic status: Middle class
  • Attitude to candidate and junior resident: Respectful, polite
  • Opening statement: “Hi Doc. Nice to see you again.”
  • Closing statement: “Thank you for your time.”

Presentation:

  • Body language: Open
  • Affect: Pleasant
  • Appearance: Clean
  • Info given spontaneously: Mr. Jackson has been overweight for the last 15 years. He is often on the road for his work and eats a lot of fast food. He finds little time to exercise and often tells jokes about his weight. He doesn’t smoke or drink excessively. He has no significant health problems other than what he is presenting for [specialty specific]. When asked by the junior resident if there is anything he would like to change he claims to know that he should probably lose weight but is happy in his life and can’t seem to find the motivation to do so.
  • Information given when prompted: His brother died of a heart attack and he’s worried the same will happen to him. He is worried about leaving his family behind but hasn’t been able to find the motivation to change his lifestyle. If prompted, he suggests that he could cut down on the fast food when he is on the road and walk to meetings instead of taking taxis.
OPENING SCENARIO FOR THE PATIENT

Background: You are a 45-year-old man who has struggled with your weight for the last 15 years. You have not had any health problems to date, and tend to make fun of your weight whenever it is brought up. You are employed as a salesman and are often on the road for work. You eat very poorly, especially on the road, and find little time to exercise. You do not smoke or drink. You are a happy person and don’t seem to be concerned about your weight on the surface. If pushed on your concerns, you note that your brother died of a heart attack and are worried that the same will happen to you. You are worried about leaving your family behind but haven’t been able to find the motivation to change your lifestyle. In talking about this, you are open to trying to improve your weight. If prompted, you can suggest that you could cut down on the fast food and walk more.

Additional notes on attitudes, concerns, expectations: You are very friendly and respectful but do not seem overly concerned about your weight. You do not initially take the conversation very seriously. If prompted to think about your concerns, you begin to take the conversation more seriously and accept the need to make a lifestyle change.

CHARACTERISTICS OF THE JUNIOR RESIDENT
  • Name: Lisa Fredricks
  • Age: 27
  • Gender: Female
  • Language: English
  • Notable physical characteristics: None
  • Clothing: Professional attire with white coat
  • Marital status: Single
  • Children: None
  • Occupation: Junior Resident
  • Education: Medical school
  • Socioeconomic status: Middle class
  • Attitude to candidate and patient: Respectful, polite
  • Opening statement: “Hi Mr. Johnson. This is my senior resident. We have reviewed your case and were hoping to discuss your eating and exercise habits with you today.”
  • Closing statement: “Do you have any other questions Mr. Johnson?”

Presentation:

  • Body language: Open
  • Affect: Pleasant
  • Appearance: Clean
  • Info given spontaneously: Will ask Mr. Johnson to clarify his eating and exercise habits. Will ask Mr. Johnson if there is anything he would like to change. Will get stuck on how to advise him to improve and turn to the senior resident for help.
  • Information given when prompted: Will be responsive to any suggestions the candidate has on things to ask or say to Mr. Johnson.
OPENING SCENARIO FOR THE JUNIOR RESIDENT

Background: You are a junior resident working in a clinic along with a senior resident. You have just seen Mr. Jackson, a 45-year-old obese male for a health supervision visit. You have completed his medical check-up and reviewed the case with the senior resident. Mr. Jackson has unhealthy eating and exercise habits, but has an otherwise unremarkable history and physical exam. You have never given lifestyle counselling before and you have asked him/her to come with you as you counsel Mr. Jackson about his weight. You will have two minutes at the end of the encounter to discuss how it went with the candidate. Please note that during the encounter, you should struggle after Mr. Jackson doesn’t offer much insight after you ask him if there is anything he wants to change. At this point, allow the candidate to step in and help you.

Additional notes on attitudes, concerns, expectations: You are a keen resident who is eager to learn and happy to receive the help of your senior resident. If the candidate does not give you feedback after the patient leaves, feel free to ask for it.


Appendix E

Direct Observation of Resident Role Modelling (DORRM) Rubric [DOC]



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