Difficulties in Residency: An Examination of Clinical Rotations and Competencies Where Family Medicine Residents Most Often Struggle

Svystun, Orysya; Ross, Shelley

doi:10.22454/fammed.2018.794779

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Professionalism is the most common reason for remediation, which is consistent with previous studies. 3,18 However, in contrast to these earlier studies, program directors reported that professionalism is not necessarily the hardest competency to successfully remediate. 19 A major challenge identified by 22% of respondents was a lack of documented evaluations to trigger or guide remediation (Table 4).…”

Section: Discussionmentioning

confidence: 85%

Resident Remediation in Family Medicine Residency Programs: A CERA Survey of Program Directors

Frazier

Wilson

D’Amico³

et al. 2021

Fam Med

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Background and Objectives: Identifying underperforming residents and helping them become fully competent physicians is an important faculty responsibility. The process to identify and remediate these learners varies greatly between programs. The objective of this study was to evaluate the remediation landscape in family medicine residency programs by investigating resident remediation characteristics, tools to improve the process, and remediation challenges. Methods: This study analyzed responses from the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2017. Survey questions included topics on faculty remediation training, remediation prevalence, tools for remediation, and barriers to remediation. Results: Two hundred sixty-seven of 503 program directors completed our survey (53% response rate). Most residency programs (245/264, 93%) had at least one resident undergoing remediation in the last 3 years. A majority (242/265, 91%) of residents undergoing remediation were successful within 12 months. The three most important tools to improve remediation were an accessible remediation toolkit (50%), formal remediation recommendations from national family medicine organizations (20%), and on-site faculty development and training (19%). The top-two challenges to the remediation process were a lack of documented evaluations to trigger remediation and a lack of faculty knowledge and skills with effective remediation strategies. Conclusions: Residents needing remediation are common, but most were successfully remediated within 12 months. Program directors wanted access to a standardized toolkit to help guide the remediation process.

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Section: Discussionmentioning

confidence: 85%

Resident Remediation in Family Medicine Residency Programs: A CERA Survey of Program Directors

Frazier

Wilson

D’Amico³

et al. 2021

Fam Med

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“…Residents lacking reliability from the perspective of the training staff were prevented to participate in shifts, emergency, or ICU wards through immediate dismissal for compelling reasons. As evidenced by the case law descriptions, the training staff appeared not to tolerate a combination of unreliability, untrainability, and incompetence in unpredictable environments with high demand for acute and critical emergency interventions [ 11 ]. Perceived future risks for patient safety were indeed accompanied reasons for dismissal in our case law, however, no incident was reported causing actual damage to patients.…”

Section: Discussionmentioning

confidence: 99%

Dutch dismissal practices: characteristics, consequences, and contrasts in residents’ case law in community-based practice versus hospital-based specialties

Godschalx-Dekker,

van Mook

2024

BMC Med Educ

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Background In the Netherlands, 2 to 10% of the residents terminate training prematurely. Infrequently, termination of training is by dismissal. Incidentally, residents may disagree, dispute and challenge these decisions from the programme directors. Resident dismissal is always a difficult decision, most commonly made after, repeated assessments, and triangulation of the resulting assessment data and one or more remediation attempts. Nevertheless, the underlying reasons for dismissal and the policies for remediation and dismissal may differ between training programmes. Such differences may however impact the chance of remediation success, the chance of dismissal and subsequent residents’ appeals. Method We included a total of 70 residents from two groups (community-based and hospital-based specialties) during 10 years of appeals. Subsequently, we compared these groups on factors potentially associated with the outcome of the conciliation board decision regarding the residents’ dismissal. We focused herein on remediation strategies applied, and reasons reported to dismiss residents. Results In both groups, the most alleged reason to dismiss residents was lack of trainability, > 97%. This was related to deficiencies in professionalism in community-based practice and medical expertise in hospital-based specialties respectively. A reason less frequently mentioned was endangerment of patient care, < 26%. However, none of these residents accused of endangerment, actually jeopardized the patients’ health, probably due to the vigilance of their supervisors. Remediation strategies varied between the two groups, whereas hospital-based specialties preferred formal remediation plans in contrast to community-based practice. A multitude of remediation strategies per competency (medical expertise, professionalism, communication, management) were applied and described in these law cases. Discussion Residents’ appeals in community-based practice were significantly less likely to succeed compared to hospital-based specialties. Hypothesised explanatory factors underlying these differences include community-based practices’ more prominent attention to the longitudinal assessment of professionalism, the presence of regular quarterly progress meetings, precise documentation of deficiencies, and discretion over the timing of dismissal in contrast to dismissal in the hospital-based specialties which is only formally possible during scheduled formal summative assessment meetings.

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“…Nevertheless, assessing professional behaviour among GP residents remains a difficult task for staff delivering training [ 3 ], in part because of a lack of cultural consensus, and the resultant breadth of the definition of “high personal standards of behaviour” [ 4 ]. Despite this difficulty, assessing professionalism during residency is important because lapses in professional behaviour form a continuum from medical school to clinical practice [ 5 , 6 ], and are related to patient complaints [ 7 ] in both underperforming GPs and residents [ 8 , 9 ]. For patients, unprofessional behaviour of doctors (in training) might result in sub-optimal outcomes regarding patients’ health, safety, and care, undermining patients’ perceptions of the trustworthiness of the individual physician as well as the profession as a whole.…”

Section: Introductionmentioning

confidence: 99%

Unprofessional behaviour of GP residents leading to a dismissal dispute: characteristics and outcomes of those who appeal

Godschalx-Dekker,

Sijbom,

Barnhoorn

et al. 2024

BMC Prim. Care

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Background Recognition of poor performance in General Practice trainees is important because underperformance compromises patients’ health and safety. However, in General Practice, research on persistent underperformance while in training and its ultimate consequences is almost completely lacking. We aim to explore the unprofessional behaviours of residents in General Practice who were dismissed from training and who litigated against dismissal. Methods We performed a structured analysis using open-source data from all General Practice cases before the Conciliation Board of the Royal Dutch Medical Association between 2011 and 2020. Anonymised law cases about residents from all Dutch GP training programmes were analysed in terms of the quantitative and qualitative aspects related to performance. Results Between 2011 and 2020, 24 residents who were dismissed from training challenged their programme director’s decision. Dismissed residents performed poorly in several competencies, including communication, medical expertise and most prominently, professionalism. Over 90% of dismissed residents failed on professionalism. Most lacked self-awareness and/or failed to profit from feedback. Approximately 80% failed on communication, and about 60% on medical expertise as well. A large majority (more than 80%) of dismissed residents had previously participated in some form of remediation. Conclusions Deficiencies in both professionalism and communication were the most prevalent findings among the dismissed General Practice residents. These two deficiencies overlapped considerably. Dismissed residents who challenged their programme director’s decision were considered to lack self-awareness, which requires introspection and the appreciation of feedback from others.

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Difficulties in Residency: An Examination of Clinical Rotations and Competencies Where Family Medicine Residents Most Often Struggle

Cited by 3 publications

References 9 publications

Resident Remediation in Family Medicine Residency Programs: A CERA Survey of Program Directors

Resident Remediation in Family Medicine Residency Programs: A CERA Survey of Program Directors

Dutch dismissal practices: characteristics, consequences, and contrasts in residents’ case law in community-based practice versus hospital-based specialties

Unprofessional behaviour of GP residents leading to a dismissal dispute: characteristics and outcomes of those who appeal

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