Mid-Year Meeting

April 8, 2017

Changing the Trajectory

of the Underperforming Learner

Nick Lonardo, PharmD

Wayne Shipley, PharmD, BCPS, BCCCP

University of Utah Hospital and Clinics

Disclosure

We have no conflicts of interest to disclose.

We will not be discussing off-label uses of drugs.

Preceptor Model of InfluencePotential Area of Influence

Preceptor Learner

Great Performer

Average Performer

Below Average Performer

Dangerous Performer

Good Performer

Practice Environment

Life and future practiceMentor

Preceptor

Trajectory

Pharmacist Objectives

1. Identify four student behaviors that characterize the underperforming learner

2. Describe three actions that will help inspire and direct new learners

3. Recognize what it means to tailor a rotation in order to optimize the learners’ chances for success

4. Given an example of an underperforming learner, demonstrate the ability to identify learning concerns and discuss ways to help change the learners’ trajectory

Pharmacy Technician Objectives

1. Identify four behaviors that characterize the underperforming learner

2. List three actions that if implemented can help inspire and direct new learners

3. Explain how a teaching scenario can be tailored to optimize the learners’ chances for success

How do we define underperformer?

Apathy, lack of interest

Tardy for work and assignment

Lack of follow-up

Failure to ask thoughtful questions

No evidence of commitment

Lack of self-direction

Underperforming Learner

Inability to solve basic problems

Lack of confidence

Poor communication skills

Poor listening skills

Lack of team ethos

Inability to concentrate on task

Performance (Knowledge x Skill)

Changing Trajectory through Performance

^(Motivation)

The same amount of effort is required from preceptors to ensure the success of all types of learners.

TRUE or FALSE

Question #1

There are three things to remember about education. The first is motivation. The second is motivation. The third one is motivation.

-Terrel Bell (Former U.S. Secretary of Education)

Motivation

Why are learners unmotivated?

Cannot do assigned work

“Response effort” needed to complete work too great

Lack of engagement in classroom discussions

Failure to see an adequate pay-off

Lack of confidence in ability to do assigned task

Lack of a positive relationship with teacher/preceptor

Motivation Deficit

Wright, J. ‘How RTI Works’ 2011

Overcoming Motivation Deficit

INTRINSIC MOTIVATION

Key in promoting learning

Doing an activity in order to achieve an internalized goal Studying because you desire to know the

subject

Competing against yourself to improve

Doing something because it’s the right think to do

Necessary for long term fulfillment

EXTRINSIC MOTIVATION

Often deemed “baseline reward” The carrot at the end of the stick

Doing an activity for an external reward Getting a good grade

Choosing to do a specific rotation because of how it will look on your CV

Have there place but need to be kept there

www.edutopia.org/blog/creating-conditions-for-student-motivation-larry-ferzallo (obtained 1/5/2017)

Overcoming Motivation Deficit

Provide the conditions for growth

Keep yourself motivated as a preceptor

Emphasize intrinsic motivation

Autonomy

Competence

Relatedness

Relevance

“Farmers and gardeners know you cannot make a plant grow… the plant grows itself. What you can do is provide the conditions for growth.”

-Sir Ken Robinson

www.edutopia.org/blog/creating-conditions-for-student-motivation-larry-ferzallo (obtained 1/5/2017)www.nap.edu/catalog/10421/engaging-schools-fostering-high-school-students-motivation-to-learn (obtained 1/5/2017)

Extrinsic

Changing Motivation

Intrinsic

(Preceptor)

(Mentor)

Which one of the following options is not an example of intrinsic motivation?

A. Staying late to help clarify drug orders because you want the patient to receive correct care

B. Signing up for a rotation in order to get a good letter of recommendation for residency applications

C. Reading the latest published therapy guidelines to keep you knowledge base accurate and reliable for your patient care

D. Attending a CE in order to improve your teaching ability

Question #2

Tailor the Rotation

Tailoring

AUTONOMY

Freedom of choice Organizational and Procedural choice

Project topics and rotational assignment

Cognitive choice Sharing thinking processes

How they arrived at conclusion

Change the process if needed No computer, different lists

COMPETENCE

Critical Feedback (done well) Positive to negative feedback at 3-1

Praising effort

Plussing Using “and” and “what if”

Schedule adaption Current patient or topics

Learners interest

www.amazon.com/building-community-self-motivated-learners-strategies by Larry Ferlazzo (obtained 1/5/2017)www.nap.edu/catalog/10421/engaging-schools-fostering-high-school-students-motivation-to-learn (obtained 1/5/2017)

Tailoring

RELATEDNESS

High-quality relationship with learner Take a genuine interest in your student

Ask questions

Act friendly and share

Be positive

Don’t give up on students Review expectations

Keep communication open

RELEVANCE

Seek for ways to help the learner discover real-life application Writing and verbal descriptions

Apply guidelines/literature to current patients

Put them on the frontline Direct patient interaction

Experience the “chirps and whistles”

(http://www.amazon.com/building-community-self-motivated-learners-strategies) by Larry Ferlazzo

Providing feedback to students should only be done on a need basis and only when the learner has done something negative.

TRUE or FALSE

Question #3

Learner Scenario #1Incredibly bright

Absorbs information

Independent

Intimidating to teach

Socially awkward

Professionalism questionable

Performance (Knowledge x Skill)

Changing Trajectory through Performance

^(Motivation)

Learner Scenario #2Huge potential

Adapts and interacts naturally

Eager to learn and apply principles

Unsure of himself

Questions authority

Life problems evident….

Performance (Knowledge x Skill)

Changing Trajectory through Performance

^(Motivation)

Learner Scenario #3Two polar learners

Both eager to express feelings

Distinct strengths and weaknesses

React differently to clinical scenarios

Motivation concerns (don’t want to be there)

Challenging to find most effective teaching method

Characteristics that define the underperforming learner

Action-based Precepting Performance equation Strengths and weaknesses

Tailor the learner’s experience Autonomy Competence Relatedness Relevance

Preceptor to Mentor Extrinsic to intrinsic motivated learners

Summary