How to address student performance issues?

Before we get into the details of the Oz protocol, I want to emphasize there’s one last step when we determine a resolution corrective action or student performance and efficiency. It’s very important that the preceptor put together a plan of follow-up. If the student’s SOAPs did not meet expectations. And the corrective action plan is that the student needs to redo the SOAP and turn it in tomorrow at four o’clock. The preceptor needs to be certain to follow up and if the student has not turn it in by four o’clock, to track the student down and make sure that it’s turned in. or invoke some additional corrective action because the students still not complying.

But the student has to understand that the preceptor is going to follow up and make sure that the corrective action is completed. So if the student has to redo the SOAP and turn it in at four o’clock. It would be up to the preceptor to make sure that’s done. First make sure that the student understands what the corrective action is. So going back to resolution, one of the aspects of resolution is very important. The final step would be if I want the student to turn a new SOAP in or to redo the SOAP and turn it in at four o’clock. It is to have a student repeat the corrective action back to me.

That tells me that the student does understand what the expectations are for the corrective action. There’s no misunderstanding. Student can say, “Oh, I didn’t realize I supposed to turn it in at four o’clock.” You have them repeat back to you and explain exactly what the corrective action is. That confirms that they understand. The preceptor then follows up and receives the corrected SOAP by four o’clock the next day. And to evaluate it and can then make a decision if the SOAP is still not of sufficient quality. Then repeat part of the PERF process and come up with a new corrective action. Or they correct the SOAP might be automatically quality, in which case the problem has been solved.

The diagnosis was made as to what the problem was. It perhaps a student didn’t understand how to write a SOAP. Perhaps the students under the misimpression of what the expectation was. Perhaps a student thought they could put less work in. But it was clarified original assignment was submitted on time. The preceptor saw that it was a adequate quality. And that concludes the corrective action process. If they didn’t perform up to standards. We need to be additional corrective action. But the key to this whole process other than good communication through the perception and expectation discussions is the Oz protocol. The Oz protocol defines how to diagnose problem. So let’s take a closer look at the detail of the Oz protocol.

That’s guaranteed preceptor technique number 13. Oz protocol means that when a student performance deficiency arises, we promptly clarify perceptions and expectations through the PERF process. We diagnose the nature of the deficiency using the Oz protocol. We implement an appropriate corrective action with follow-up. The Oz protocol tells us how to diagnose and ensure appropriate action. It’s based on the concept of situational leadership which means that the nature of leadership interaction between the leader and follower should be based on the nature of the deficiency and certain deficiencies were certain types of intervention. And we need to make sure that we match the deficiency to the corrective action.

The Oz protocol is actually based on a movie, an old movie called “The Wizard of Oz.” You might not be familiar with the movie. It came out about the time I was born which were giving an indication how old this movie is. But the gist of the movie is that there’s three characters, a Scarecrow, a Cowardly Lion, and a Tin Woodsman, would encounter a young girl by the name of Dorothy. And they are each in need of something. Scarecrow is in need of a brain. Scarecrow lacks knowledge likes competence and watched the Wizard of Oz to provide a brain. The Cowardly Lion obviously is cowardly and wants courage.

So we can think of the Cowardly Lion is in need of confidence. And the Tin Woodsman is in need of a heart, which we can correlate to commitment. So these three characters represent the need for commitment, competence and confidence. We’ll go one by one through these three characters and they can guide us to a diagnosis of the student performance deficiency. As an example, Scarecrow is need of a brain that represents the deficiency of competence. Student simply doesn’t have sufficient knowledge or skill to perform up to expectations. And using the SOAP as an example, student does not know how to write a good SOAP. The corrective action for that deficiency would involve direction. Directing the students. Providing more clear instructions.

Or oversight or offering them an opportunity to practice and feedback. But showing the student what needs to be done to correct the deficiencies. Helping them resolve the gap and knowledge or skill. Helping them to gain competence in doing whatever it is we want them to do. Now the Tin Woodsman lacks a heart as the need of commitment. So, if the problem is not one of competence, student knows how to write a good SOAP but the student lacks commitment. Student doesn’t seem to care about writing a good SOAP now. Perhaps doesn’t understand the importance of a pharmacist being able to SOAP a patient. That student needs coaching, not directing. And coaching, we might explain the rationale a little bit better.

Try to help the student understand the importance when emphasize that importance in a variety of ways or even provide an incentive. Some additional rewards to offer to the students if they do a good job of completing the assignment. The third possible diagnosis is one of the lack of confidence. This relates to the Cowardly Lion, who needs courage. Now it’s not a problem of competence the student knows how to write a SOAP. They’re committed to writing a good SOAP, but they fear that they don’t have the ability to write a good SOAP. And they’re hesitant for that reason. That would require a more supporting type of leadership or direction. Not direction I should say.

A more supportive type of of leading and educating the student. To provide support and to provide acknowledgement for the student’s effort. Perhaps praise when the student does succeed doing it correctly. The students might be able to need a little push to try something outside his or her comfort zone. And a student is uneasy talking to a position about a patient. They lack confidence in talking with physicians. The preceptor might offer to come along and assist the students, “OK! you initiate the discussion I’ll be there, in case you get stuck, in case you have a problem. I’ll be there to support you.

This is something I used to do when I would have a pharmacist first engage in aminoglycoside dosing of patients. They lacked confidence that they had the ability to do so. So I offered to come alongside them and review their work before they actually made a recommendation of new dosing change. The idea here is that if competence is the problem, provide direction. If commitment is the problem, coach them to be more committed, to better understand the need for commitment. And if confidence is the problem, provide support to them. To increase the confidence. They can feel more comfortable engaging the behavior. And lastly, include Dorothy as the fourth possible diagnosis because Dorothy is represented.

She wasn’t in search of anything from The Wizard of Oz. Dorothy was OK, so that represents no real deficiency. Sometimes the performance is not up to part, because there was simply a misunderstanding of the expectations. In the perfect process, the preceptor learns that is indeed the reason for the problem, that the students simply didn’t understand what the expectation were. Then the solution is simply to clarify those expectations and then empower the student to go ahead and and fix the problem. Or the problem might have been one of lack of resources. Students lack certain information that was needed for the SOAP. So the preceptor can help the students figure out how to obtain that information.

Whether the case may be, a diagnosis of competence deficiency, commitment deficiency, or confident deficiency, is critically important in identifying a corrective action that will match the deficiency. And if there really is no deficiency, and it’s just a matter of clarifying the expectations and correcting any misunderstanding.