Success Stories

Tony Mason III, MD

2000 - 2002 TOT Participant
Albany Medical College

How Teaching of Tomorrow Improved Your Teaching:
I became more aware of the resident's needs particularly with regard to attitudes. I felt more empowered to listen to the resident and learn more about her individual point of view. Earlier I might have dismissed her as a "difficult learner" and perhaps not progressed further.

Description of the Teaching Setting:

Tony's Story ~
Improving Resident's End of Life Care- February 2002

I worked with one of the first year residents during her first rotation in the hospital. At one point we admitted an elderly woman from a nursing home who was critically ill with one severely ischemic leg and a creatinine of 9.0. We discussed the patient and the third year resident and I came to the conclusion that the lady was dying and that we would provide palliative care. The first year resident was greatly distressed that we were "giving up on the patient" and that this was not our role to make value judgments about who should live and who should die.

Later in the year the same resident was working with me and now we had several hospice patients on our service. The residents first reaction was to say that she would take care of the other patients and she would leave the hospice care to the third year resident. Her avoidant behavior and attitude did not allow for engaging the patient.

I then talked with her more about her beliefs. She had come to the residency out of the military where her primary role had been urgent care. She had little experience with geratrics or with end of life care. In the hospice she felt frustrated and useless. We then talked together with the third year resident and worked out a plan whereby the first year would take primary care of hospice patients with the third year as support. This offered her the chance to explore her own attitudes, discuss her ideas with her colleagues and then practice working with patients. I would then assess how she was doing based on her own comfort level and how she would function when making rounds together.

I used the techniques of modeling when talking to a patient about spiritual issues. The resident was able to perform specific tasks relative to listening to the patient. She also was given reading material about end of life care. Through this process she was able to begin working with patients in a more active way and she was able to have more insight into her own relationship with patients. Evaluation consisted of observation at the bedside, her presentation and discussion of patients and asking her directly about her attitude.