Orientation workshop
on Medical Education
Group Dynamics
Dealing with Difficult People
Session Objectives
By the end of the session, the participants
should be able to

Demonstrate that he/ she can interact effectively
within the group

Discuss the attributes which can facilitate group
discussion and those which can hamper group
discussion
STAGES OF GROUP BEHAVIOR

1. Forming

2. Storming

3. Norming

4. Performing

5. Adjourning
Agenda

Stages of Group Behavior

Types of Difficult People/Behavior

Do’s and Don’ts of Managing Difficult Interactions
with Types of Difficult People/Behavior

General Tips and Strategies
Understanding Difficult Behavior

Difficult people are usually a result of conflicting
personalities not because of intentional behaviors

If you notice someone is more difficult around you
than others, it may be because your personalities
clash

It’s important to remember we can all be difficult
whether we mean to or not

NO FEAR! I’ll give you some tips to help you deal…
Recognizing Difficult People

Some key characteristics
 They’re
never satisfied
 “I
pay to go here, I should get to do whatever I want.”
 “I
pay my student activity fee! Do this program now!”
 They
don’t communicate easily with others
 “Because
I said so.”
 They
can be argumentative and unreasonable
 They
often use their power to obstruct
 “Do
 “I
you know who my father is?”
will sue you.”
“Resistance is thought
transformed into
feeling. Change the
thought that creates the
resistance, and there is
no more resistance.”
-
Robert Conklin
Recognizing Difficult People

"Coping With Difficult People" by Robert M.
Bramson, Ph.D. identifies seven different types of
difficult people/behavior:
◦
The “Sherman Tank”
◦
The “Exploder”
◦
The “Complainer”
◦
The “Clam”
◦
The “Wet Blanket”
◦
The “Know-It-All”
◦
The “Staller”
The “Sherman Tank”
Characteristics

Always on the attack

Abusive

Intimidating

Overpowering

Always right

Lack of caring and
respect for others
Do’s and Don’ts

Don’t worry about being
polite; Just get your point
across any way you can

Don’t argue with what they
say

Don’t try to cut them down

Do maintain eye contact

Do state your own opinions
and thoughts forcefully
without apology

Do be ready for negotiation
The “Exploder”
Characteristics
Temper tantrum
behavior
 Raging outbursts that
are out of control
 Shout, throw things,
and often say
regrettable things
 Behavior result of
feeling threatened
and cannot cope with
the situation

Do’s and Don’ts

Do give them time to wind down

Do switch to a problem-solving
mode of interaction

Do use active listening skills to
show that you take their concerns
seriously

Don’t allow for them to maintain
behavior in a public area (Move to
a more private area to calm down)
The “Complainer”
Characteristics

Finds fault with everything

Hold idea that someone
should be doing something
about their problems


Will not engage in
productive problem solving
discussion
Often feel powerless to
change the situations that
they complain about
Do’s and Don’ts

Do listen attentively to their
complaints

Do show them you hear them
by using paraphrasing or
summarizing

Do state the facts without
comment

Do ask the complainer “How
do you want this discussion to
end?’

defense-reaccusation pattern
develop
The “Clam”
Characteristics
Do’s and Don’ts

Silent

Do ask open ended questions

Just “yes” and “no” answers

Do wait for a response

Hard to open us


Maintain stance
Do be patient and plan to
spend extra time with them

Easily mask fear and anger


Refuse to cooperate

Won’t effectively
communicate
Do comment on what is
happening during interaction
and “discussion”

Don’t break silence while
waiting for a response
The “Wet Blanket”
Characteristics





Responds to anything
with a quick and
negative response
Has the “it won’t
work, don’t bother”
attitude
Feel as though
everything is out of
their control
Bitter about life
Negative and critical
Do’s and Don’ts

Do know your own tendencies of
pessimism

Do be optimistic and realistic in
interaction

Do consider possible negative
outcomes of the problem

Do be prepared to take action
on your own

Don’t argue them out of their
pessimism
The “Know-It All”
Characteristics
“Expert” on all
matters
 Feel others are
stupid or uninformed
 Often react to
others’ knowledge
with anger,
withdrawal, or
irritation
 Likes control of
everything

Do’s and Don’ts

Do be prepared and have all
information possible

Do listen carefully and
paraphrase main points

Do be tentative in
disagreements

Do use questions to raise
problems

Don’t act like a Know-It-All
back
The “Staller”
Characteristics
Do’s and Don’ts
Indecisive
 Lack follow-through
 Leave others to do
work
 Undependable
 Typical response is no
response
 Cannot make up their
minds

Do be open to listening to
conflicts and difficulties
Stallers have in making
choices and decisions

Do listen for indirect cues for
underlying issues

Do use problem solving
techniques

Do concentrate on facts

Do support any decision
making the Staller can offer

General Tips and Strategies
Be proactive
o
Have a plan
o
Prepare for worst possible situation
Listen
o
Look and sound like you are listening-Maintain
eye contact, nod your head and look interested
o
If the other person senses that you care and
that you’re interested, they’re likely to
become more reasonable
Principles of Learning
Learning Styles
Dr. Syed Hasan Shoaib
Head, Department of Medical Education
Shalamar Medical and Dental College, Lahore
Session Objectives
By the end of the session, the participants
should be able to:

Identify principles of adult learning

Discuss three main learning styles
Teacher Centered
Teacher Centered
Teacher Centered
Teacher Centered
Teacher Centered
Student Centered
Student Centered
Student Centered
Case studies
SCENARIO 1:
You had a 45 minute lecture on Toxicology, in which the
lecturer came & started speaking on arsenic, dhatura
(atropine), and strychnine, its toxic doses, morbid effects,
causes of death in case of their poisoning, and postmortem findings. At no time did he encourage any of you
to even speak.
SCENARIO 2:
This was immediately followed by another 45 minute
lecture in General Surgery. The teacher talked about types
of abdominal incisions. He started by asking you layers of
the abdominal wall, and their anatomy you had read in
previous years. He constantly engaged your attention by
asking repeatedly the muscles incised for various incisions,
& highlighting with color slides.
Please discuss which lecture you will remember more and
WHY ?
YOU HAD LEARNING SESSIONS ON THE FOLLOWING TOPICS:

Physiology of sleep with examples from sleep patterns of
your class fellows.

Forensic aspects of suicide with examples from several
real cases from this week’s newspapers

Management of chest pain with examples from patients
you saw in the emergency in the last two days.
ON ANOTHER DAY YOU HAD LEARNING SESSIONS OF SAME
DURATION WITH SIMILAR A-V AIDS ON:

Course and relations of the axillary artery

A factual description of Kreb’s cycle

A detailed description of management of
Mucopolysachharidosis
CASE STUDY 3
While going for post graduation which was the
major force which helped you learn?
Which method of learning was used for learning in
post graduation?
PRINCIPLES OF ADULT LEARNING

Adults learn when they are active participants of
the learning process

Adults are goal oriented

Adults learn from activation of prior knowledge
and experience

Adults are relevancy oriented and apply meaning
to what they learn (Contextual learning)

Adults are self-directed learners and take
responsibility for their own learning

Adults learn using Multiple modes of instruction
Learning Style Models
 Fleming's
VARK or VAK model
 Kolb’s
Learning Style
 Honey
and Mumford learning style
VARK/VAK Model
 VARK?
 Visual
 Auditory
 Read/write
 Kinesthetic
Visual
 Visual
learners prefer
Pictures
Flash
cards
Diagrams
movies
Auditory learners
 Learn
best through
Lectures
Discussions
Tapes
Pod
casts
Tactile /Kinesthetic learners
 Prefer
to learn via
Moving
Touching
Doing
CONTEXT
There are different types of students in
your class. Some of them are auditory
learners, some visual learner and the
others are Kinaesthetic learners.
TASK
How will you plan your teaching
learning session so that you cater to all
different types of learners?
SYSTEM’S APPROACH
OBJECTIVES:

By the end of the session, the participants should
be able to:

Discuss the steps of Systems approach
SYSTEM’S APPROACH
Objectives
Evaluation
Planning
SYSTEM’S APPROACH
Objectives
Evaluation
Instructional
Strategy
Principles of
Evaluation
Principles of
Learning
EDUCATIONAL OBJECTIVES
Dr. Syed Hasan Shoaib
Department of Medical Education
SESSION OBJECTIVES
By the end of the session, the participants
should be able to:

Classify the Educational Objectives according to
Bloom’s taxonomy
BLOOMS TAXONOMY
Cognitive
domain: Knowledge
outcomes, intellectual abilities and
thinking skills.
Psychomotor
Affective
domain: motor skills.
domain: Attitudes, interests,
appreciation, and modes of adjustment.
Classification of cognitive domain
 Cognition
1 (C1): Recognition & recall
 Cognition
2 (C2): Application
 Cognition
3 (C3): Analysis
C1
C2
C3
HIERARCHICAL ORDER OF THE
CATEGORIES IN THE COGNITIVE DOMAIN
2nd Classification
Evaluation
Synthesis
Analysis
Application
Comprehension
Knowledge
5
3
Classification of Psychomotor Domain
 Imitation
 Control
 Automation
Writing Learning Objectives
SESSION OBJECTIVES
At the end of session, the participants should
be able to:

Differentiate between students centered learning
and teacher centered learning

Develop Learning Objectives
Why write Objectives?
Writing clear objectives is important because:
 Objectives
define what you will have the
students do
 Clear
objectives help teachers foster higher
level thinking skills in their students
 The
objectives guides you towards
assessment
State them as student performance
By the end of the session/ unit/ course,
a student is able to:

List the organisms
pneumonia

Differentiate between a normal and an abnormal
X-Ray chest

Outline a management plan for a patient with
congestive heart failure.
involved
in
causing
Don’t state them in terms of:
•Teacher
Performance
inflammation)
(e.g.
•Learning
Process (e.g. student learns
concept of immunization)
•Course
content
(e.g.
studies
management of enteric fever)
teach
the
the
STEPS FOR STATING LEARNING
OBJECTIVES

Make a blanket statement

Begin with an action verb that mentions
performance

Include enough specific learning objectives to describe
adequately the performance of students who have
attained the objective.

The Objectives should be Performance based so that
they can be evaluated

Keep the specific learning objectives
comprehensive and not too restricting.
observable
sufficiently
Verbs to Avoid
Understand
 Know
 Learn
 Comprehend
 Appreciate
 Familiarize
 Realize
 Be aware of

Knowledge
Define
Name
Describe Outline
Identify
Recall
Label
Recite
List
Select
Match
State
Remembering
or Recall of
Information
Comprehension
Define
Describe
Identify
Label
List
Match
Name
Outline
Recall
Recite
Select
State
Understanding
of given
information
Application
Change
Compute
Demonstrate
Develop
Modify
Operate
Organize
Prepare
Relate
Solve
Transfer
Use
Using strategies,
concepts, principles
and theories in new
situations
Analysis
Break down
Infer
Deduce
Diagram
Differentiate
Distinguish
Illustrate
Outline
Point out
Relate
Separate out
Subdivide
Breaking
information
down into its
component
elements.
Synthesis
Categorize
Compile
Compose
Create
Design
Devise
Formulate
Predict
Produce
Putting together ideas or
elements to develop a
original idea or engage in
creative thinking.
Evaluation
Appraise
Compare
Contrast
Criticize
Defend
Judge
Justify
Support
Validate
Judging the value of ideas,
materials and methods by
developing and applying
standards and criteria.
Teaching
methods
SESSION OBJECTIVES
At the end of session, the participants should
be able to:

Identify different teaching methods

Differentiate between teaching methods and
teaching aids

Relate Teaching methodologies with Educational
Objectives
Common Teaching Methods

Discussion

Lecture

Tutorial

Demonstration or Practical

Role play

Buzz group

Brainstorming
Some rare methods

Independent learning
 Directed
 Self
self learning
directed learning

Distance learning

Computer assisted learning

Peer Assisted learning
Difference between teaching
methods and teaching aids

Teaching method is a method chosen to teach e.g
lecture, SGD etc.

Teaching aid is a tool which is used to aid the
teaching method e.g. lecture can be supported by
Flip charts, multimedia etc.
Matching objectives to Teaching methods
Type of Objective
Cognitive:
knowledge Problem
Psychomotor:
Skills Performance
Affective:
Lectures
SGD
+++
+
+
+
++
++
+
PBL
Demo
++
+
+++
+
Models/
Simulatio
n
+
++
Methods
Solving
++
+++
+
++
+
++
+
+
+
++
Spectrum, Sins, and Myths
about Medical Professionalism
Dr. Mohamed M. Al-Eraky
Medical Education Manager, IMC, Jeddah, KSA
Researcher, Center for Medical Education,
Dundee University, Scotland UK
• Define Professionalism
• Discuss the 7 sins of
unprofessional behaviour
The definition of professionalism is too abstract
Wear, 2004
There have been calls for operationalizing the definition of
professionalism
Hafferty, 2004
How to define
Medical Professionalism
?
Professions
are occupations granted a special status in and by society.
Professionals
are a self-disciplined group of individuals who hold out to
the public (profess) as possessing specials skills after long
training or education and are prepared to exercise that skill
for the interest of others.
Value of
Medical Professionalism
Professionalism:
a contract between medicine and society
(The Social Contract)
Sylvia R. Cruess, Richard L. Cruess, JAMC • 7 MARS
2000; 162 (5)
Expectations
Obligations
The World Health Organization has defined
the social accountability of medical schools
as:
“The obligation to direct their education, research
and service activities towards addressing the priority
health concerns of the community, region, and/or
nation they have a mandate to serve…
Medical
professionalism is
our behavior as
physicians. It is
how we conduct
ourselves as
physicians in our
interactions with
our patients and
society.
Medical professionalism encompasses the
values, behaviors, and attitudes inculcated
into us by our medical school education
and postgraduate training along with our
daily experiences.
Medical professionalism is greatly
influenced by our social values and norms.
Therefore, it remains a flexible concept,
despite maintaining a core set of values.
(McDonaugh, 2008)
Swick’s normative definition of professionalism:
Medical Professionalism comprises the following
set of behaviors exhibited by physicians:
Subordinate your interest to the interest of others;
Adhere to high ethical and moral standards;
Respond to societal needs;
Show core humanistic values;
Exercise accountability;
Demonstrate a commitment to excellence;
Exhibit a commitment to scholarship;
Reflect upon your actions and decisions.
The Accreditation Council for Graduate Medical
Education
It is an independent, private sector, voluntary,
not-for-profit organization responsible for
evaluating and accrediting all residency
programs in the USA.
Accreditation Council for
Graduate Medical Education
The
6 General Competencies
1.Patient Care
2.Medical Knowledge
3.Practice based Learning & Improving
4.Interpersonal & Communication skills
5.Professionalism
6.System based practice
Professional responsibilities
defined by the charter on professionalism
Commitment to:
•
•
•
•
•
•
•
•
•
•
Professional competence
Honesty with patients
Patient confidentiality
Maintaining appropriate relations with patients
Improving quality of care
Improving access to care
A just distribution of finite resources
Scientific knowledge
Maintaining trust by managing conflicts of interest
Professional responsibilities
(ABIM, Annals of Int Med, 2002)
12 Learning Outcomes
1.
2.
3.
4.
5.
6.
7.
Clinical skills
Practical Procedures
Patient Investigation
Patient Management
Health Promotion & Disease Prevention
Communication
Information Management
8. Principles of Social Basic & Clinical Skills
9. Attitude, Ethics and Legal Responsibilities
10.Decision Making, Clinical Reasoning & Judgment
11.Role as a Professional
12.Personal Development
http://www.obstgyn.ca/Education/docs/CanMEDS2005_e.pdf
CanMEDS 2000 Project –
Royal College of Physicians and Surgeons of Canada
As a Professional, the Specialist should be able to:
Deliver the highest quality care with integrity, honesty and
compassion.
Exhibit appropriate personal and interpersonal professional
behaviors
Practice medicine in an ethically responsible manner that respects
the medical, legal and professional obligations of belonging to a
self-regulating body
Royal College of Physicians London 2006
Medical professionalism signifies a set of
values, behaviors and relationships that
underpins the trust the public has in doctors
Spectrum
of Medical Professionalism
Giving priority to pt. interests
Being answerable to pt. society &
profession
Perform beyond expectations, & lifelong CPD
Consistency of actions, values, methods,
measures, principles, expectations & outcome.
Being fair, truthful, straightforward
Free acceptance of commitment to achieve the highest
possible standards of patient care
For others (pt., families, colleagues, students,
trainees)
The 7 Sins
of Unprofessional Behavior
Seven issues that challenge or diminish
the previously identified elements of professionalism.
I would rather call them:
• Patient encounters
• Interaction with junior
colleagues
• Bias
• Sexual Harassment
• Breach of confidentiality
Medicine itself might develop
arrogance (vanity)
‫الكِـبر‬
Q.: Define arrogance?
So, how to vaccinate our
medical students against
arrogance/vanity?
Greed for:
- Fame
- Power
- Money
Lying
Hiding truth or part of it
Fraud
A misrepresentation of material
facts with the intent to mislead
Examples:
‘’you don’t have cancer’’ (lying)
‘’You should have an MRI, it’s under insurance’’ (fraud)
The inability of physicians to
perform their professional
obligations
Problem:
Borderline impairment!
Obstacles
1- Impaired physicians frequently can not recognize their
limitation and may not acknowledge their impairment
2- Who will be the whistle blower? (reluctance to report)
Commitment to the …
minimum
 Takes the most abbreviated history
 Wait for x-ray reports rather than viewing x-ray personally
 Do not return family calls
 Blames bureaucracy and the system for every problem
 Get the update from Pharma. Co. (not evidenced)
 Does not show for committee meetings , attend late, or without contribution
• Self-referral
• Acceptance of gifts
• Utilization of services
• Collaboration with
industry
• Bias in research
Thank You
Introduction to
Educational Leadership
Dr. Syed Hasan Shoaib
Acknowledgment

Some of the slides have been taken from Dr.
Gohar Wajid presentation. We acknowledge his
contribution
Educational Leadership
LEARNING OUTCOMES:

Differentiate between Leader and Manager

Discuss the role of Communication in Leadership

Identify the Qualities of effective leader
Leaders vs Managers
Set direction and develop
vision
Plan, budget, organize
Produce change
Manage change
New paradigm
Work within an existing
paradigm
Challenge systems
Provide order & consistency
within organization
Seek new opportunities
Manage existing resources
Align, motivate and inspire
people
Solve problems
Do the right things
Do the things right
Leadership vs Management
Both leadership &
management are essential and
required for an organization.
Think about one great leader
and tell one quality that
makes him great leader
The Leadership Challenge

Leadership is an observable, learnable set of
practices. Leadership is not something
mystical that cannot be understood by
ordinary people. Given the opportunity for
feedback and practice, those with the desire
and persistence to lead – to make a
difference – can substantially improve their
abilities to do so.
(Kouzes and Posner)
Leadership is NOT about audience
Leadership is NOT about followers
Leadership is NOT just to be #1
Leadership is NOT just to be different
Leadership is NOT about centralization
Leadership is NOT about chief commanding
Leadership is about bridging gaps
Leadership is about working in teams
Team work divide efforts but multiplies results
Insert Team Theme
Leader as a good Communicator
Leader as Problem Solver
THANK YOU