Terrific T6 talks – The Problem Learner

In Education & Quality Improvement by Nadim LalaniLeave a Comment

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  • Reflect on the type of student that annoys/clashes with you.
  • What type of student do you have no idea how to work with?

Generally teachers avoid voicing negative feelings towards learners, but in truth there will always be a student that pushes your understanding, patience and goodwill to the limit. How do you deal? Here are some hopefully helpful tips.

Understanding Problem Learners

Generally, two kinds of problems exist with learners – knowledge and attitude

Knowledge Gap [e.g. medication doses and drugs]

Comes from:

  1. Not having been taught [institutional factors, teacher factors, learner factors]
  2. Not having understood the concept
    • Learning styles/Attention/different processing styles
    • Learning issues
    • Language barrier

Lack of knowledge acquisition can be remedied by:

  1. Self directed learning [often the default]. Here’s a great take on encouraging the autodidact from an interesting young blogger.
  2. Educational prescriptions [not just about knowledge, but also ways of remembering that stuff]
  3. Job aids/Instruction

Lack of understanding:

  1. Tutors my be needed
  2.  Creating effective learning that motivates and engages . You need both content expert  and facilitator skills if you’re going to be of any use to your students.
  3. Engaging support systems [from the institution – this also means giving them feedback e.g. if 1/2 the students coming through ER have never heard of “reciprocal EKG changes” – that’s a problem with the College that needs to be fixed]

Attitude Gap

  1. Unconscious incompetence on the part of the learner
  2. Clash [i.e. your countertransferance]. Are they really incompetent? Could this be your negative feelings?

Unconscious incompetence can be corrected by engaging the learner:

  • They need to be aware [“I have noticed that…”]
  • Avoid the judgmental statement. Instead of “I have noticed that you seem unmotivated” … try ” I have noticed that you only see one patient per hour… why do you think that is the case?”
  • BE SPECIFIC … stick to the facts. [hard to argue against facts]


The root cause could be cultural issue [trained elsewhere, or is from a culture that goes about things differently]

Can arise from differing values [I’m too senior to do scut work, differing values on dress code, generation gaps]

Expectations [poor orientation given to the learner – came wearing jeans expecting to be provided some scrubs]

The Impaired learner

Why not try the CALMER technique:

Catalyst for change –

  • is there a danger to patient, staff?
  • where are they in the learning cycle?
  • what part of the situation do I have control over?
  • who might you bring to help? [Rotation coordinator, Program Director, Undergrad Dean]

Alter your own thinking:

  • How does this learner make me feel?
  • Am I projecting my values/assumptions on them? [assumptions lead to negative behavior that will only make things worse]
  • Is this getting in the way?
  • How can I challenge my assumptions.

Listen and then Diagnose:

  • Encourage self-assessment [will let you know where they are in the learning cycle]
  • Reinforce the positives
  • Be specific

Make an agreement:

  • Ask student how they can modify behavior [gives them ownership]
  • Decide whether this is acceptable or whether there needs to be action at this point

Education and Follow-up

  • What does the student need to modify the behavior
  • Enlist help from educational support/rotation coordinator/department head
  • Refer

Reach out:

  • You need to vent about this. Grab a colleague and go over for a beer and a vent session. [do not do this in public]
  • Close the door and move on.
Nadim is an emergency physician at the South Health Campus in Calgary, Alberta. He is passionate about online learning and recently made a transition into human performance coaching. He is currently working on introducing the coaching model into medical education.