Title: Competency Problems: Managing Performance, Attitudinal, Ethical, and Legal Issues with Interns and P
1Competency Problems Managing Performance,
Attitudinal, Ethical, and Legal Issues with
Interns and Postdoctoral Fellows
- Nadine Kaslow, Ph.D., ABPP, APPIC Past-ChairJeff
Baker, Ph.D., ABPP, APPIC Vice-Chair/CoA Rep - Mona Koppel Mitnick, JD, APPIC Public Member
2ACKNOWLEDGE PROBLEM STUDENT WORKGROUP
- Nadine Kaslow, Ph.D. Sue Jacobs, Ph.D
- Nancy Rubin, Ph.D. David Miller
- Stephen Behnke, Ph.D. Laurie Mintz, Ph.D.
- Sherry Benton, Ph.D. Victor Pantesco, Ph.D.
- Steve Dollinger, Ph.D. Rebecca Schwartz-Mette
- Nancy Elman, Ph.D. Craig Shealey, Ph.D.
- Linda Forrest, Ph.D. Beverly Thorn, Ph.D.
- Catherine Grus, Ph.D. Barbara Van Horne, Ph.D.
- Steven Huprich, Ph.D. Kristi Van Sickle
3GUIDING PRINCIPLE 1
- Define key terms (competence, competencies,
capability, impairment, benchmarks), establish
benchmarks for performance, and develop a
categorization schema
4COMPETENCE
- Personal ability, adequacy, capability, capacity,
efficacy, efficiency, and proficiency
5COMPETENCE
- Habitual and judicious use of communication,
knowledge, technical skills, reasoning, emotions,
values, and reflection in daily practice for the
benefit of the individual and community being
served that involves habits of mind, critical
thinking and analysis, professional judgment in
assessing situations and ascertaining appropriate
responses, and evaluating and modifying decisions
via reflective practice - (Epstein Hundert, 2002)
6COMPETENCIES
- Knowledge, skills, and attitudes, and their
integration - Correlate with performance
- Can be enhanced through training and development
-
Attitudes
Knowledge
Skills
7CAPABILITY
- Extent to which individuals can adapt their
skills, generate new knowledge, improve their
performance, and engage in life-long learning - Fraser Greenhalgh, 2001
-
8IMPAIRMENT
- Historically, has described interference in
professional functioning associated with
substance use, mental illness, or personal
conflict
9IMPAIRMENT
- Recently, characterized as a condition that
interferes with professional functioning to the
extent it negatively impacts clients/patients or
makes effective service delivery impossible - APA Board of Professional Affairs Committee on
Colleague Assistance, 2006
10IMPAIRMENT
- Impairment has a specific meaning in the context
of the ADA (medical or mental health disability)
and thus legal implications ensue for its use - Some trainees with competence problems also have
impairments according to the ADA
11BENCHMARKS
- Reflect standard for measurement of performance
that can be used for comparison and to identify
where needs for improvement exist - Connote task or performance indicators
- Can capture minimal level of each competency for
each stage of professional development
12COMPETENCE PROBLEMS
- Indicate interference in professional functioning
- Can be observed though maladaptive patterns of
behavior or performance or via critical incidents - May occur when performance fails to meet expected
benchmarks, repeat patterns of mistakes occur, or
as acquired incompetence or impairment in the
form of diminished functioning
13COMPETENCE PROBLEMS
- Can be categorized based on
- Origin (situational, developmental, problematic
personality and interpersonal dynamics) - Severity and chronicity
- Potential for remediation
- Manifestation
14COMPETENCE PROBLEMS
- May be exhibited when individuals
- Do not have adequate training, education, or
experience opportunities - Are unable to acquire professional skills and
reach an accepted level of competency
(performance problem) - Are unable or unwilling to acquire and integrate
professional standards into their behavior - Fail to respond to feedback or remediation
efforts - Do not continuously grow, change, or make
progress
15COMPETENCE PROBLEMS
- May be exhibited when individuals
- Lack self-awareness with regard to weaknesses
- Have problems with professionalism and/or
interpersonal interactions - Exhibit prejudicial attitudes and values
- Lack high levels of integrity
- Have personal problems, emotional reactions, or
distress that they are unable to control and that
affect their professional functioning (conduct or
emotional problem)
16COMPETENCE PROBLEMS
- Insufficient professional competence can be
manifested in foundational competencies, such as - Errors in judgment, ethicality, and
professionalism (e.g., boundary violations) - Maladaptive interpersonal attributes
- Problematic character or fitness
- Lack of self-awareness of areas of weakness
- Lack of progress toward achieving benchmarks
- Lack of response to feedback
17COMPETENCE PROBLEMS
- Insufficient professional competence can be
manifested in functional competencies, such that
people do not exhibit the expected level of
knowledge, skills, and attitudes in one or more
domains
18PERSONAL RISK FACTORS
- History of childhood trauma
- Substance use disorders
- Major Axis I disorder
- Axis II disorder
- Interpersonal insensitivity
- History of parentification
- Wounded healer
- False self
- Difficulties with attachment and
separation-individuation
19PROFESSIONAL RISK FACTORS
- Prejudicial attitudes and values
- Difficulties managing multiple roles
- The role requirement for heightened sensitivity
to people and the environment - Isolation in the work place
- Vicarious traumatization and compassion fatigue
- Lack of time for self-care
- Limited capacity for self-reflection and
self-assessment
20COMPETENCE PROBLEMS
- Do not include a trainees behavior, attitudes,
or characteristics that are developmentally
normative, such as - Transition issues
- Mild performance anxiety
- Mild discomfort with diverse client groups
- Initial lack of understanding of the facilitys
norms - Lack of certain skills sets, but an openness and
readiness to acquire them
21CONTEXT
- Identification of a trainees behavior as
reflecting competence problems needs to take the
context into account - Key to assess if trainee difficulties reflect a
mismatch between the - Philosophy of the site and the trainees
orientation - Skills and competencies of the trainee and the
demands of the site
22CONTEXTUAL FACTORS
- Contextual factors in the life of the trainee
need to be considered - Adjustment issues to new setting (not site)
- Adjustment to new site
- Separate from established support systems
- Status change
- Personal life events/changes
- When the aforementioned issues appear salient,
- Suggest options for better stress management and
self-care - Provide more support to the trainee
23GUIDING PRINCIPLE 2
- Prepare the system so that decision-makers
undertake appropriate assessment processes and
make and communicate assessment decisions
24CHALLENGES IN EVALUATING TRAINEES (Gizara
Forest, 2004 Robiner, 1993)
- Definition and Measurement Issues
- Lack of clear criteria and objective measures of
and competence problems - Supervisor awareness of subjectivity inherent in
evaluation - Apprehension about defending evaluations due to
lack of clear criteria and objective measures
25EVALUATION CHALLENGES
- Legal and Administrative Issues
- Concern that negative evaluations may result in
administrative inquiry, audit, grievance, or
litigation - Lack awareness of internship/residency or
institutional policies and procedures involved in
negative evaluations - Concern about lack of support from administrators
and colleagues - Concern that failing to pass an intern/resident
may result in loss of future training funds or
slots or the need to find additional funds to
extend the trainees training - Concern that failing to pass an intern/resident
may result in adverse publicity that could affect
institutional reputation and number of applicants
26EVALUATION CHALLENGES
- Interpersonal Issues
- Fear of diminishing rapport or provoking
hostility from supervisees - Fear of eliciting backlash from current or future
trainees - Anguish about damaging a supervisees career or
complicating or terminating their graduate
training (in the case of an intern)
27EVALUATION CHALLENGES
- Supervisor Issues
- Lack preparation for the evaluative components of
supervision - Wish to avoid scrutiny of their own behavior,
competence, ethics, expectations, or judgment of
their clinical or supervisory practices - Have limited supervisory experience with trainees
with competence problems - Have difficulties in imparting negative
evaluations - Indifferent to personal responsibility for
upholding the standards of the profession - Display inappropriate optimism that problems will
resolve without intervention
28EVALUATION CHALLENGES
- Supervisor Issues (cont.)
- Prefer to avoid the substantial energy and time
commitment necessary to address or remediate the
behavior of interns and residents with competence
problems - Have discomfort with gatekeeper role
- Identify with supervisees problems
- Pay inadequate attention to supervisees
performance or problems - Presume supervisee competence
- Minimize supervisees problem behavior
29POLICIES AND PROCEDURES
- Policies and practices need to
- Be consistent with local and national
professional, ethical, and legal standards, yet
tailored to the program - Be communicated clearly and explicitly to
trainees and others - Include knowledge, skills, and attitudes defined
as professional behaviors and performance - Delineate minimal acceptable standards of
professional performance and criterion signaling
need for remediation and/or dismissal - Convey clear expectations
- Give trainee a time-limited opportunity to
improve - Be understood to everyone in the system
- Articulate defensible practices for assessing
competence
30DUE PROCESS GUIDELINES
- Create in a fashion that is simple and easy to
understand - Communicate in writing and orally to each
intern/post doc at outset of training - Apply uniformly and in a timely fashion to all
trainees exhibiting competence problems - Apply to all serious performance, conduct,
attitudinal, and ethical problems
31DUE PROCESS PROVISIONS
- Describe types of problems and behavior covered,
which should be broad enough to cover all
performance, conduct, attitudinal, and ethical
deficiencies, and combination of deficiencies - Describe persons covered, making clear that all
trainees are covered - State the time limits at different stages of the
process, and whether and for what reasons time
limits may or may not be waived
32DUE PROCESS PROVISIONS
- Offer informal and formal procedures for
notifying about deficiencies and penalties,
correcting deficiencies, and appealing
dissatisfaction with the programs compliance
with the procedures - Identify clearly at each stage the decision maker
and the contents of the decision - State clearly at each stage whether and to whom
the complainant or training program official may
appeal the decision - Note when decision becomes final
33GUIDING PRINCIPLE 3
- Cultivate self-assessment capacity for learning
and responding to feedback for the purpose of
identifying and addressing competence challenges
and preventing competence problems
34VALUE OF SELF-ASSESSMENT
- Reflective practice/self-assessment is a
foundational competence and needs to be taught
and encouraged - Lacking the capacity to self-assess is tantamount
to failing to attain professionalism, missing the
skill of thinking like a psychologist, and being
insulated against self-corrective behavior
35CULTURE OF SELF-ASSESSMENT
- Must provide training in self-assessment that is
bolstered by concurrent monitoring and feedback
from other informants and that offers assistance
in incorporating and integrating input from
multiple sources - Training should emphasize developing the capacity
to examine issues that elicit discomfort to
master experiences and reduce negative
performance impact
36CULTURE OF SELF-ASSESSMENT
- Cultivating a climate of trust and help-seeking
among supervisors, mentors, and colleagues
reduces tension that often occurs when addressing
competency problems and this climate requires
empathy, concern, and respect for others, and is
best achieved if evaluators assess fairly and
empathically
37GUIDING PRINCIPLE 4
- Implement remediation strategies to enhance
performance and evaluate in a systematic fashion
that is balanced in terms of reliability and
authenticity and designed to maximize learning,
and utilize gatekeeping functions when indicated
38FULL DISCLOSURE
- Inform trainees at outset that competence will be
comprehensively assessed in an ongoing fashion - Provide
- Rationale for such assessment
- Specifics of assessment system
- Implications or usage of assessment information
39METHODS OF EVALUATION
- Consider relevance, fidelity, authenticity, and
validity - Use direct observation in actual or simulated
situations for skills and attitudes - Use multiple samples of behavior, multiple
evaluators, and multiple methods over time
40FORMATIVE AND SUMMATIVE EVALUATION
- Formative evaluations
- Ongoing and regular performance feedback at
specified intervals - Critical in measuring and remediating competence
problems - Guide the development of learning objectives in a
remediation plan based on strengths and
weaknesses - Global rating scales, portfolios, 360 degree
evaluations
41FORMATIVE AND SUMMATIVE EVALUATION
- Summative evaluations
- Measure endpoints or outcomes
- Less well-suited for guiding the remediation
process - Can determine success (or failure) of a
remediation - Both summative and formative methods need to be
employed in situations of competence problems
42PROCESSES ASSOCIATED WITH COMPETENCE PROBLEMS
(Lamb et al., 1991)
- Setting the Stage
- Orientation
- Communicate sites expectations about
professional standards, skill competency,
personal functioning - Communicate about evaluation guidelines and
processes - Provide Due Process Guidelines
43PROCESSES
- Reconnaissance and Identification
- Gather on-going evaluative information and
observe the trainees initial response to the
setting, training experience, and feedback - Discuss among all training faculty/staff
- Identify areas of concern orally and in writing
express concerns as hypotheses and define problem
behaviors in concrete and specific terms - Monitor early and continuously
- This process often is enough to manage many
problems
44PROCESSES
- Discussion and Consultation
- Hold discussions among all training personnel
when problems persist regarding other
interventions and next steps - Consider
- Actual behaviors of concern (e.g., nature,
frequency, severity) - Settings that behaviors occur in
- Negative consequences of the behaviors
- Trainees response to feedback
45PROCESSES
- Implementation and Review
- Implement remediation plans
- Review progress and response to interventions
- Communicate with all relevant parties
- Provide ongoing feedback
- Document all problem behaviors and changes in
behavior - Hold ongoing meetings of faculty/staff for review
- Consult with other training personnel
- Consider possible alternative actions
- Seek external consultation
46PROCESSES
- Anticipating and Responding to Organizational
Reaction in Cases of Termination - Support trainee and help him/her consider
alternatives - Support training personnel
- Determine how to communicate what and to whom
(e.g., other current and future trainees, staff) - Manage clinical services
47PROCESSES
48REMEDIATION PLANS
- Implement to assist the individual in gaining the
requisite competence and to avoid gate-slipping - Craft a written document with a constructive and
educative tone - Identify specific deficits and relate these to
previously communicated benchmarks
49REMEDIATION PLANS
- Delineate explicitly expectations for
improvement, including - Contexts in which the behaviors occur
- Level at which sufficient competence will have
been deemed to have been achieved - Projected time line for the achievement of the
objective and/or re-evaluation of both the
competence and plan efficacy - Present objectives, followed by descriptions of
the training methods for achieving the objective,
as well as roles and responsibilities for all
parties and for the institution (if applicable)
50REMEDIATION PLANS
- Incorporate one or more strategies to remediate
problems - Increase supervision, either with the same or
other supervisors - Change the format, emphasis, and/or focus of
supervision - Reduce and/or shift the trainees workload
- Require specific academic coursework
- Provide additional mentoring
- Recommend personal psychotherapy
51REMEDIATION PLANS
- Incorporate one or more strategies to remediate
problems - Recommend, when appropriate, a leave of absence
and/or a second internship or residency - Collaborate with the graduate department on the
remediation plan in accord with the CCTC
Communication Guidelines
52REMEDIATION PLANS
- Personal Psychotherapy
- Convey that therapy may help with understanding
why issues reflect competency problems or
overcoming the psychological barriers that hinder
the making of required changes - Consider ethics and due process rights in
ascertaining if a referral is appropriate
53REMEDIATION PLANS
- Personal Psychotherapy
- Be mindful of informed consent, avoid dual
relationships, attend to cultural background, use
qualified providers, clarify confidentiality,
tend to financial concerns, and clarify the
manner in which therapy contacts will be used in
the evaluation process - Establish written plans regarding recommending
psychotherapy and strategies for evaluating the
outcomes of personal psychotherapy
54REMEDIATION PLANS
- Use measures and methods of assessment of
competence problems that complement and can be
integrated into such plans (e.g., behavioral
observations, review of work samples) - View objectives, assessment, training, and
evaluation as a continuous process - Discuss and agree upon the plan
55FORMAL ACTIONS
- When a combination of the above interventions do
not, after a reasonable time period, rectify the
problem, or when the trainee seems unable or
unwilling to alter his/her behavior, the program
may need to take more formal action in accord
with their due process guidelines
56FORMAL ACTIONS(Lamb et al., 1991)
- Probation
- In writing,
- Identify specific behaviors or areas of
professional functioning of concern - Relate these behaviors to written evaluations
- Provide specific ways deficiencies can be
remedied - Identity specific probationary period
- Stipulate how functioning will change at site
during probation, of applicable - Reiterate the availability of due process
procedures
57FORMAL ACTIONS
- Give the trainee a limited endorsement, including
the specification of those settings in which
he/she could function adequately - Terminate the trainee from the program and
communicating this to the appropriate parties - Recommend and assist in implementing a career
shift for the trainee - All of the above steps need to be documented
appropriately and implemented in accord with the
due process guidelines
58TERMINATION(Lamb et al., 1991)
- Steps to take prior to notifying trainee
- Review agency and institutional implications of
the decision - Determine how and when the trainees status will
change at the site - Review proposed action and corresponding written
statement in consultation with relevant internal
and external parties - Consult with legal counsel at the facility
- Notify up the chain of command
59TERMINATION
- Once these steps have been taken
- Hold meeting between the trainee and relevant
training and site personnel - Inform trainee of the decision
- Provide a written statement to trainee and other
relevant parties reiterating probationary
conditions, trainees response, and reasons for
dismissal - Provide statement of revised responsibilities
- Remind trainee of due process guidelines and
appeal options
60GUIDING PRINCIPLE 5
- Consider the impact of beliefs, values, and
attitudes about individual and cultural
differences on decisions regarding problem
identification, assessment, and intervention
61DIVERSITY AND COMPETENCE PROBLEMS
- Must attend to diversity in remediation and
dismissal to not perpetuate divergence between
cultural and professional norms - Must be cognizant of the role that individual and
cultural differences may play in identification
or action taken with students perceived as having
competence problems
62DIVERSITY AND COMPETENCE PROBLEMS
- Be mindful of over- or under-identifying
problematic behavior due to - Cultural naivete
- Fear of appearing racist or sexist
- Difficulty addressing the complexity in the
intersection of cultural difference and
competence problems - Inverted positional power
- Differential standards based on bias
- Fear of litigation
63GUIDING PRINCIPLE 6
- Communicate across levels of training,
professional organizations, and credentialing
boards as appropriate
64ETHICAL ISSUES
- Supervisors should outline their roles at the
outset of supervision, which aids in the building
of trust relationships (Principle B Fidelity
and Responsibility) - Supervisors should define a trainees areas of
growth and make clear that their behavior
(positive and negative) is fair game for
evaluation within supervision and for reports to
training programs - Respect for student rights is important and
judicious, balanced, thoughtful communications
are essential
65LETTERS OF RECOMMENDATION
- Tendency to inflate letters of recommendation,
despite the fact that the receiver of letters
want truthful and complete evaluations - May want to consider adopting the CCPPP
guidelines for competency-based letters that ask
for attention to core competencies, skills (work,
communication, interpersonal), personal
resources, and professional conduct, as well as
areas for growth and development
66INCREASED COMMUNICATION
- More frequent and direct communication across
levels (e.g., graduate school internship) is
desirable - Graduate schools and internship trainers should
collaboratively address students insufficient
professional competence
67GUIDING PRINCIPLE 7
- Maximize transparency through the identification
and communication of limitations to the
individuals rights to privacy and confidentiality
68ETHICAL, LEGAL, REGULATORY STANDARDS
- Limitations to individuals rights to privacy and
confidentiality need to be publicly identified in
advance of any actions and must be appropriate
and sensitive to ethical, legal, and regulatory
standards - Family Educational Rights and Privacy Act (FERPA)
- Americans with Disabilities Act (ADA)
- Health Insurance Portability and Accountability
Act (HIPAA)
69ETHICAL, LEGAL, REGULATORY STANDARDS
- APA Ethics Code provides guidance on the
conditions under which students may be required
to disclose personal information (i.e., program
identifies in its materials when such an
exception might occur and the information is
needed to evaluate or obtain assistance for
students whose personal problems may prevent them
from competently performing or pose a threat to
others (7.04)
70ETHICAL, LEGAL, REGULATORY STANDARDS
- Appropriate use of confidentiality should not
interfere with sufficient assessment and
intervention - Limits on confidentiality protect the public and
the profession - Profession needs to distinguish between real and
presumed constraints on confidentiality that
apply to the training of psychologists
71TRANSPARENCY
- Enhancing transparency measures we should not use
the cloak of confidentiality to create barriers
to assessing and remediating competence problems - When problematic professional behavior
jeopardizes professional standards, the right to
confidentiality needs to be limited due to
substantial consequences to the public and
profession - When rights to confidentiality conflict with
professional standards, confidentiality
automatically becomes limited
72CONFIDENTIALITY INTERVENTION
- Concerns about protecting the confidentiality of
individuals with competence problems frequently
contribute to a failure to intervene in a way
that prevents or remediates problems until they
are severe and/or have caused harm - When psychotherapy is part of remediation,
assumptions about confidentiality often keep key
information from being usable in remediation
outcomes (not necessary for specific information
to be disclosed, but attestations of gains in
understanding and modifying professional
competence are helpful)
73CONFIDENTIALITY INTERVENTION
- Ethics Code addresses
- Balance between concerns about privacy and due
process rights and need for accountability to
protect the profession and the public - Fact that students do not have to disclose
personal information unless it is a program
requirement or the information is needed to
ensure competent functioning - Fact that if therapy is mandated then students
can opt for therapists unaffiliated with the
program and that those who evaluate students can
not serve as their therapists
74CONFIDENTIALITY INTERVENTION
- Consider (Behnke et al., 2003)
- Law of no surprises people are informed in
advance what will be disclosed and to whom - Parsimony principle What is disclosed is
limited to what is required to achieve the
purposes of the disclosure (i.e., issues related
to professional competence and only to those who
need to know)
75CONFIDENTIALITY INTERVENTION
- Concerns about protecting the confidentiality of
individuals with competence problems frequently
contribute to a failure to intervene in a way
that prevents or remediates problems until they
are severe and/or have caused harm - When psychotherapy is part of remediation,
assumptions about confidentiality often keep key
information from being usable in remediation
outcomes
76GUIDING PRINCIPLE 8
- Ethical, regulatory, and legal implications must
be considered
77ETHICS
- Competence is the cornerstone of ethics (APA
Ethics Code) - Only by practicing in a competent manner can one
fulfill the 1st principle (Beneficence and
Nonmaleficence) - Psychologists strive to benefit those with whom
they work and take care to do no harm - Psychologists provide benefit and avoid harm by
being competent at what they do conversely,
incompetence increases the risk of harm and
minimizes the likelihood of benefit
78REGULATIONS
- Competence is central to the regulations of many
jurisdictional psychology boards - Regulations emphasize competence in 3 ways
- Set forth the conditions by which to determine if
applicants for licensure have achieved the
necessary competence to practice independently - May provide continuing education requirements for
maintenance of competence and identify areas for
specific attention - Dictate the adjudicatory processes that govern
allegations of incompetence in the provision of
services and the consequences that follow when
psychologists fall below the necessary standard
of competence
79LEGAL IMPLICATIONS
- Actions in malpractice or negligence lawsuits are
based upon breach in the standard of care - Psychologists owe a duty to their
clients/patients to exercise reasonable care
(legal gold standard) - When psychologists fall below the standard and
cause harm, they may be liable in malpractice
actions - To practice in an incompetent fashion would be to
fall below the standard of care
80LEGAL IMPLICATIONS DISABILITY ISSUES
- A great deal of confusion has arisen among
interns/postdoctoral residents and their sites
/programs as to what constitutes disability, as
defined by the Rehabilitation and Americans with
Disabilities Acts and what, if any, obligation
an internship/program site has to provide
reasonable accommodation to an applicant or an
intern/postdoc after selection
81CLAIMING AND PROVING DISABILITY
- Qualified
- Responsibility for Determination
- Toyota vs. Williams
- Rehabilitation Act or ADA
- Correctible
82ACCOMMODATION
- When and to What Extent Reasonable Accommodation
is Required - Reasonable Accommodation
- Establish Meeting the Definition
83HANDICAP DISCRIMINATION
- Avoiding a Successful Claim of Handicap
Discrimination
84REFERENCES
- Rehabilitation Act of 1973, as amended (29 U.S.C.
sec. 791 et seq. and Americans with
Disabilities Act of 1990 (ADA (42 U.S.C. sec.
12101 et seq. 29 C.F.R. sec. 1630 1997 EEOC
Enforcement Guidance on the Effect of
Representations Made in Applications for Benefits
on the Determination of Whether a Person Is a
"Qualified Individual with a Disability" Under
the Americans with Disabilities Act of 1990 (ADA)
(Feburary 12, 1997) Enforcement Guidance
Reasonable Accommodation and Undue Hardship Under
the Americans With Disabilities Act (March 1,
1999).
85REFERENCES
- Sutton v United Airlines, 527 U.S. 471 (1999)
- Murphy v U.S. Parcel Service, 527 U.S. 516 (1999)
- EEOC Enforcement Guidance on ADA and Psychiatric
Disabilities (1997) Addendum (2000) - Instructions for Field Offices Analyzing ADA
Charges after Supreme Court Decisions Addressing
Disability and Qualified (1999)
86APPIC RESOURCES
- Informal problem resolution and consultation
process - Formal complaint process (ASARC)
87APPIC TRAINING RESOURCESwww.appic.org
- Training Resources
- By Subject
- For Trainers
- Reference Lists
88VIGNETTE 1
- The intern has been slowly withdrawing from their
cohorts and you as the TD notice this. When
asked, her response is they just seem to be on
different wave lengths. You also are getting a
couple of complaints from patients that the
psychology intern is rude. She seems pleasant to
you and has denied this problem with patients and
you acknowledge that patients with chronic pain
can be difficult to work with. On further
inquiry, the secretary in the office notices that
the psychology intern is very short with her and
other office personnel. What do you do?
89VIGNETTE 2
- The postdoc has very good clinical skills and
seems to have good work habits the first 6
months. You have noticed that he is not taking
much initiative lately and seems to be slacking
off. He has begun looking depressed and lacks
energy. This problem was addressed 1 month ago,
but the number of sick days have increased and
non attendance at grand rounds and other
functions has become non existent. He always
seems to have a good excuse. What do you do?
90VIGNETTE 3
- The intern is a quad that ambulates in a
motorized wheelchair. She is eccentric in her
dress, has fingernails that draw attention, has
visible body piercings that she is proud of, and
discusses the importance of her individuality at
length. Her skills are average. She has
recently received complaints about racing her
wheelchair through the hallways of the rehab unit
sometimes startling patients. What do you do?
91VIGNETTE 4
- The postdoc has several research projects going
on and has not been very good about following
through on their responsibilities. You are not
sure if they are overwhelmed, just a poor
organizer or poor research skills. What
interventions might you consider before it
becomes a major problem?
92VIGNETTE 5
- The intern has been unusually helpful during the
year and has always completed tasks in a
reasonable fashion. He is very independent and
you sometimes wonder if he is expressing contempt
for his colleagues and supervisors. Several
things have happened to initiate you taking a
closer look - 1) An MMPI was returned by mail from the prison
system and he claims the hospital inmate had
taken it while they must not have been looking.
93VIGNETTE 5
- 2) One patient called to express dissatisfaction
with the way she was treated by this intern,
stating he lashed out at her by tearing up her
MMPI and saying it was worthless. He states that
never happened. - 3) The secretary went to lunch with him and
reported that the intern had made disparaging
remarks about the program, the training director
and one supervisor, stating the supervisor had
made sexual advances toward the intern. The
intern and the secretary met with the TD and the
intern claimed he never made those remarks, that
everything was fine. - How would you proceed?
94QUESTIONS?