National Survey of Internal Medicine Residency Program Directors Regarding Problem Residents (original) (raw)
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The challenge of problem residents
Journal of General Internal Medicine, 2001
Internal medicine residency training is demanding and residents can experience a wide variety of professional and personal difficulties. Residency programs everywhere have had and will continue to have problem residents. Training programs should be equipped to effectively identify and manage residents who experience problems. Previous articles that have been published on the topic of problem residents primarily addressed concerns such as impairment due to depression and substance abuse. The content of this article is derived from a comprehensive review of the literature as well as other data sources such as interviews with program directors and workshops at national professional meetings. This article focuses primarily on four issues related to problem residents: their identification, underlying causes, management, and prevention. The study attempts to be evidencebased, wherever possible, highlighting what is known. Recommendations based on the synthesis of the data are also made. Future ongoing studies of problem residents will improve our understanding of the matters involved, and may ultimately lead to improved outcomes for these trainees.
BMC Medical Education, 2016
Background: The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world such as the Scandinavian countries, where healthcare systems are slightly different. The aim of this study was to examine prevalence and characteristics of residents in difficulty in one out of three postgraduate medical training regions in Denmark, and to produce both a quantifiable overview and in-depth understanding of the topic. Methods: We performed a mixed methods study. All regional residency program directors (N = 157) were invited to participate in an e-survey about residents in difficulty. Survey data were combined with database data on demographical characteristics of the background population (N = 2399) of residents, and analyzed statistically (Chi-squared test (Χ 2) or Fisher's exact test). Secondly, we performed a qualitative interview study involving three focus group interviews with residency program directors. The analysis of the interview data employed qualitative content analysis. Results: 73.2 % of the residency program directors completed the e-survey and 22 participated in the focus group interviews. The prevalence of residents in difficulty was 6.8 %. We found no statistically significant differences in the prevalence of residents in difficulty by gender and type of specialty. The results also showed two important themes related to the workplace culture of the resident in difficulty: 1) belated and inconsistent feedback on the resident's inadequate performance, and 2) the perceived culturally rooted priority of efficient patient care before education in the workplace. These two themes were emphasized by the program directors as the primary underlying causes of the residents' difficulty. Conclusions: More work is needed in order to clarify the link between, on the one hand, observable markers of residents in difficulty and, on the other hand, immanent processes and logics of practice in a healthcare system. From our perspective, further sociological and pedagogical investigations in educational cultures across settings and specialties could inform our understanding of and knowledge about pitfalls in residents' and doctors' socialization into the healthcare system.
Journal of Graduate Medical Education, 2009
The chief resident plays an important role in internal medicine residencies, being positioned at the nexus between faculty and residents. The position is considered one of honor and prestige and provides a mark of distinction when applying for fellowship positions. 1,2 The job description may differ from one program to the next, ranging from a junior faculty position with high clinical demands to a more administrative office with expectations to lead recruiting efforts. It traditionally has a heavy didactic responsibility. Administrative, management, and personnel skills are crucial for a successful chief resident. 3 Chief residents act as role models, 4 build teamwork, 5 identify problem residents, and give constructive feedback. 6 Chief residents act as a link and advocate for residents to the program administrationcomparable to a ''middle manager.'' 7,8 They also organize grand rounds, facilitate morning reports, and provide bedside teaching while attending on hospital wards. 9 To date, no studies have addressed the demographics and dayto-day work life of chief residents. Our study attempted to provide these data using a nationwide survey of internal medicine program directors. Methods The Survey Committee of the Association of Program Directors in Internal Medicine (APDIM) is charged with developing questionnaires to track the baseline characteristics of the internal medicine residencies in the United States and to address current issues facing residencies and residency directors. The Survey Committee designed the questionnaire used in this study to include a section with
Sao Paulo Medical Journal, 2011
CONTEXT AND OBJECTIVE: Previous studies have attempted to understand what leads physicians to label patients as 'dificult'. Understanding this process is particularly important for resident physicians, who are developing attitudes that may have long-term impact on their interactions with patients. The aim of this study was to distinguish between patients' self-rated emotional state (anxiety and depression) and residents' perceptions of that state as a predictor of patients being considered dificult. DESIGN AND SETTING: Cross-sectional survey conducted in the hospital of Universidade Federal de São Paulo (Unifesp).
BMC Medical Education, 2011
Background: Despite there being considerable literature documenting learner distress and perceptions of mistreatment in medical education settings, these concerns have not been explored in-depth in Canadian family medicine residency programs. The purpose of the study was to examine intimidation, harassment and/or discrimination (IHD) as reported by Alberta family medicine graduates during their two-year residency program. Methods: A retrospective questionnaire survey was conducted of all (n = 377) family medicine graduates from the University of Alberta and University of Calgary who completed residency training during 2001-2005. The frequency, type, source, and perceived basis of IHD were examined by gender, age, and Canadian vs international medical graduate. Descriptive data analysis (frequency, crosstabs), Chi-square, Fisher's Exact test, analysis of variance, and logistic regression were used as appropriate. Results: Of 377 graduates, 242 (64.2%) responded to the survey, with 44.7% reporting they had experienced IHD while a resident. The most frequent type of IHD experienced was in the form of inappropriate verbal comments (94.3%), followed by work as punishment (27.6%). The main sources of IHD were specialist physicians (77.1%), hospital nurses (54.3%), specialty residents (45.7%), and patients (35.2%). The primary basis for IHD was perceived to be gender (26.7%), followed by ethnicity (16.2%), and culture (9.5%). A significantly greater proportion of males (38.6%) than females (20.0%) experienced IHD in the form of work as punishment. While a similar proportion of Canadian (46.1%) and international medical graduates (IMGs) (41.0%) experienced IHD, a significantly greater proportion of IMGs perceived ethnicity, culture, or language to be the basis of IHD. Conclusions: Perceptions of IHD are prevalent among family medicine graduates. Residency programs should explicitly recognize and robustly address all IHD concerns.
The nature of general surgery resident performance problems
Surgery, 2009
Background. Residents with performance problems are challenging to program directors and complicate the work of other residents and health care providers. Having an effective, targeted remediation process to address these problems is dependent on being able to diagnose their nature. The purpose of this study was to identify residents who had serious, substantive, and recurring academic, clinical, and/or professional behavior problems, and to describe and classify their nature. Methods. Raters performed a retrospective record review of general surgery categorical residents in one program over 30 years. Residents with substantial problems were reviewed, described, and classified independently by 3 raters. Results. Seventeen residents had serious enough performance problems to be included. Four had only 1 class of problem (3 were professional behavior problems). Eight residents had 2 problems each (5 academic and clinical performance problems; 3 clinical performance and professional behavior problems). Five residents had 3 problems. The number of performance problem facets per case varied from 11 to 2 with an average of 5.9 facets. Relations with health care workers was identified most frequently, followed closely by insufficient knowledge. Poor communication was third. Performance problems of 14 residents (82%) were identified in their first year. For 15 cases, the resident had unresolved performance problems at the end of the program. Conclusion. There are 2 possible explanations for our findings: (1) resident problems similar to these are refractory to remediation; (2) treatments used historically are not well designed for the problems. Choosing among the 2 explanations will require developing remediation strategies targeted to specific patterns of performance problems. (Surgery 2009;145:651-8.) From the Southern Illinois University School of Medicine, Springfield, IL RESIDENTS WITH PERFORMANCE PROBLEMS often consume substantial time and attention from the program director and educational staff. Additionally, these resident problems complicate clinical care and increase the patient care workload of other health care providers due to the added monitoring, increased communication demands, and other duplication of patient care effort required.