EXERCISES: BECOMING A TRAINER
Challenging Training Situations
Purpose: For each of the cases listed, please consider various ways that you might respond as a trainer. These exercises are meant to build your skill and adaptability to difficult clinical, behavioral, ethical, and clinic flow issues in training while keeping in mind the unintentional biases that enter into these situations.
- You start off with the values clarification exercises with a trainee who is shy but friendly. After a brief introduction, they tell you that they are struggling over whether or not to provide abortions. They feel it is hard to “help someone commit a sin.” They would feel better if only they could spend a lot of time with each patient to make sure that they thought abortion was the right decision for that patient. They especially wanted to avoid doing abortions for those who “use it as birth control”. The trainee states, “Clearly some patients make bad decisions for themselves, so I cannot trust that they are making the right decision about this.”
- A trainee frequently asks to leave early and expresses interest only in procedural skills. They tend to sit back and avoid saying much during counseling sessions. You notice toward the end of the day that they demonstrate even less engagement with patients of color.
- You are assisting a trainee with a patient who desires a medication abortion. While reviewing the chart you notice that the patient’s listed pronouns are he/they. While observing the trainee counseling, you hear the trainee misgender the patient using she/her during the counseling session. You step in promptly and say, “Oops, so sorry we just got your pronouns wrong–can we confirm that you use he/they as I see here in the chart? Reflect on this encounter and how a trainer can model being an ally.
- You have a trainee joining you today at the clinic who identifies as a Black woman. This is her first training day and she is very excited to begin her abortion training. She arrives a few minutes late to the huddle, her hair is down (which you have not seen before) and she seems a little frazzled. Just after she arrives, the clinic manager leading the huddle makes a comment about professionalism, specifically about tardiness and appropriate appearance. When the huddle is over the resident apologizes and explains that she was not able to find parking, but you note that her demeanor seems off for the remainder of the day. The following training day the resident is reserved and you note that her hair is again pulled back. How do you proceed?
- You are assisting a trainee in a procedure on a patient who shared during counseling that they are anxious about pain. During the dilation, the patient starts fidgeting and becomes noisier. The patient then becomes more active on the table, withdrawing from each cervical dilation by the trainee, and starts crying loudly in the middle of the dilation. How do you proceed?
- A somewhat new trainee continues to dilate beyond appropriate size and use too much pressure with their instruments. The trainee suddenly has a look of discomfort, and mentions quietly “I felt some obstruction and a slight tearing feeling.”
- The last couple days in your training clinic, you’ve noticed the clinic flow seems to be less than optimal, with longer patient waiting times, and your staff having to staying an hour longer each day this week. How might you approach this problem?