The basic principles and components of the RP&L method can be adapted to fit a variety of learning targets, levels of professional development, institutional constraints and resources. The following sections provide examples of variations in design.
Monthly, One-Hour Rotational Seminar for Interns in a Pediatric Hematology/Oncology Inpatient Unit
Setting: 36-bed inpatient pediatric hematology-oncology unit
Target: Understanding the physician’s role in situations of threat and loss
Title: Tragedy, Communication and the Pediatrician’s Role
Typical Learner Group: 5-6 1st year interns in pediatrics and one 2nd year resident
Educators: 1 attending physician faculty, 1 fellow, 1 psychologist with occasional participation of a generalist pediatrician
Time Frame: 1 hour
Typical Term of Participation by Learners: 1 seminar
Brief Description: Near the middle of each month residents rotating through the Hematology/Oncology Service participate in a seminar facilitated by the attending, the fellow, a generalist pediatrician, and a psychologist. The purpose of the seminar is to learn how to communicate with and support children and families during times of severe strain and tragedy. The seminar is an opportunity to reflect on and articulate what the residents have experienced and observed during this rotation. In particular, it offers them the chance to reflect on the role of the physician and the importance of communication skills as they consider their future careers in pediatrics. The timing of the seminar also allows residents to adjust their learning objectives for the remainder of the month. The format of the seminar is basically an opportunity for an explicit discussion of these issues. At the beginning of the month the residents are provided a written description of the seminar. In preparation for this seminar they are asked to reflect on the following questions in the days leading up to the seminar:
- What are your career plans at this point in time?
- What were your expectations about this rotation before the month began? How do your experiences compare to your expectations?
- What have you observed in terms of child and family responses to strain and tragedy and the physician’s role in these circumstances? What have you learned about the physician's role and communication that is applicable to your career? What do you want to incorporate into your own repertoire? What do you question?
At the time of the seminar the residents are each asked to respond to the first two questions. This establishes the fact that the seminar will be interactive and that residents will be asked to discuss their experiences and approaches to difficult situations. The third question, posed to participants as a group, allows residents to describe the wide variety of challenging circumstances they have encountered. Participants typically ask attending physicians and fellows how they have navigated these situations (e.g., directly discussing death with a child).
Every seminar ends with residents completing a brief written evaluation, which combines rating scales and open-ended questions. It is noteworthy that the most frequent comment about the seminar is how helpful it is to hear about the experiences of seasoned physicians as they navigate through challenging situations.
All of our faculty and fellows participate in this seminar. There is no particular preparation required. The facilitator simply follows the basic principle of ensuring that participants explain why they do what they do.