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Noreen H, Yasmeen R, Mohammad SA. Factors leading to lapses in professional behaviour of Gynae residents in Pakistan: a study reflecting through the lenses of patients and family, consultants and residents. BMC MEDICAL EDUCATION 2024; 24:611. [PMID: 38831320 PMCID: PMC11149338 DOI: 10.1186/s12909-024-05509-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 05/02/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Professional behaviour is the first manifestation of professionalism. In teaching hospitals, the residents can be considered vulnerable to lapses in professional behaviour when they fail to meet the set standards of professionalism. Residents of some specialties are more at risk of lapses in professional behaviour due to the demanding nature of work. Research focusing on the behaviour of residents in the field of Gynae and the underlying factors contributing to such behaviour is notably lacking in the literature. Additionally, there is a gap in understanding the perspectives of patients from Pakistan on this matter, as it remains unexplored thus far, which constitutes the central focus of this study. An increase in complaints lodged against Gynae resident's professional behaviour in Pakistan Citizen Portal (PCP) was observed. Therefore, an exploratory qualitative study was conducted to investigate the factors and rationales contributing to the lapses in resident's professional behaviour. The study collected the viewpoints of three stakeholder groups: patients and their families, consultants and residents. The study was conducted in three phases. First, the document analysis of written complaints was conducted, followed by face-to-face interviews (11 per group) conducted by trained researchers from an independent 3rd party. Finally, the interview data was transcribed, coded and analysed. In total 15 themes were identified from the interviews with 3 stakeholders, which were then categorized and resulted in 6 overlapping themes. The most prevalent lapse reported by all 3 stakeholders was poor verbal behaviour of residents. CONCLUSION The highly ranked factors contributing to triggering the situation were associated with workplace challenges, well-being of residents, limited resources, patients and family characteristics, patients' expectations, lack of administrative and paramedic support, cultural factors and challenges specific to Gynae specialty. Another intriguing and emerging theme was related to the characteristics of patients and attendants which helped in understanding the causes and implications of conflicting environments. The value of competency also emphasized that can be accomplished by training and mentoring systems. The thorough examination of these factors by key stakeholders aided in accurately analysing the issue, its causes, and possible solutions. The study's findings will assist higher authorities in implementing corrective actions and offering evidence-based guidance to policymakers to improve healthcare system.
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Affiliation(s)
- Humera Noreen
- Department of Obstetrics &Gynaecology, Rawalpindi Medical University, Rawalpindi, Pakistan.
| | - Rahila Yasmeen
- Department of Medical Education, Riphah International University, Islamabad, Pakistan
| | - Shabana Ali Mohammad
- Department of Medical Education, Riphah International University, Islamabad, Pakistan
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Godschalx J, van Mook W. Dismissed Psychiatry Residents Who Appeal: Exploring Unprofessional Behavior. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:344-351. [PMID: 36853268 PMCID: PMC10447273 DOI: 10.1007/s40596-023-01746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Dutch psychiatry residents who are dismissed from their training program have the opportunity to appeal the decision. Those appeals are publicly available. This report explores the appeals of residents dismissed for unprofessional behavior. METHODS The authors analyzed caselaw of dismissed psychiatry residents brought before the conciliation board of The Royal Dutch Medical Association and compared them to a control group of caselaw of dismissed family medicine residents. RESULTS From 2011 to 2020, 19 psychiatry residents were dismissed for failing to meet the competencies of the CanMEDS professional domain and matched with 19 family medicine residents. Most psychiatry residents deficient in professionalism were considered deficient in their attitude, in reliability of keeping agreements, or in their ability to profit from supervisors' feedback. Insufficient professional behavior overlapped with insufficient communication, collaboration, and management. Half of the psychiatry residents with deficits in professionalism went on sick leave at some time. Between residents in psychiatry and family medicine, or between psychiatry residents with and without a favorable conciliation board decision, no statistical differences were found regarding gender, year of residency, and number of insufficient competencies. CONCLUSIONS The deficiencies in the professionalism of residents who challenged their program director's decision to be dismissed mostly consisted of inadequate attitude or the inability to profit from feedback, suggesting that these residents lack empathy, introspection, or both.
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Affiliation(s)
- Judith Godschalx
- Flevoziekenhuis Almere GGZ Centraal Flevoland, Almere, The Netherlands
| | - Walther van Mook
- Maastricht University Medical Centre+, Maastricht, The Netherlands
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Mills LM, Boscardin C, Joyce EA, Ten Cate O, O'Sullivan PS. Emotion in remediation: A scoping review of the medical education literature. MEDICAL EDUCATION 2021; 55:1350-1362. [PMID: 34355413 DOI: 10.1111/medu.14605] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Remediation can be crucial and high stakes for medical learners, and experts agree it is often not optimally conducted. Research from other fields indicates that explicit incorporation of emotion improves education because of emotion's documented impacts on learning. Because this could present an important opportunity for improving remediation, we aimed to investigate how the literature on remediation interventions in medical education discusses emotion. METHODS The authors used Arksey and O'Malley's framework to conduct a scoping literature review of records describing remediation interventions in medical education, using PubMed, CINAHL Complete, ERIC, Web of Science and APA PsycInfo databases, including all English-language publications through 1 May 2020 meeting search criteria. They included publications discussing remediation interventions either empirically or theoretically, pertaining to physicians or physician trainees of any level. Two independent reviewers used a standardised data extraction form to report descriptive information; they reviewed included records for the presence of mentions of emotion, described the mentions and analysed results thematically. RESULTS Of 1644 records, 199 met inclusion criteria and were reviewed in full. Of those, 112 (56%) mentioned emotion in some way; others focused solely on cognitive aspects of remediation. The mentions of emotion fell into three themes based on when the emotion was cited as present: during regular coursework or practice, upon referral for remediation and during remediation. One-quarter of records (50) indicated potential intentional incorporation of emotion into remediation programme design, but they were non-specific as to how emotions related to the learning process itself. CONCLUSION Even though emotion is omnipresent in remediation, medical educators frequently do not factor emotion into the design of remediation approaches and rarely explicitly utilise emotion to improve the learning process. Applications from other fields may help medical educators leverage emotion to improve learning in remediation, including strategies to frame and design remediation.
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Affiliation(s)
- Lynnea M Mills
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christy Boscardin
- Department of Anaesthesia and Perioperative Care and Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth A Joyce
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Patricia S O'Sullivan
- Departments of Medicine and Surgery, University of California, San Francisco, San Francisco, CA, USA
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Abstract
There are myriad types of problem learners in surgical residency and most have difficulty in more than 1 competency. Programs that use a standard curriculum of study and assessment are most successful in identifying struggling learners early. Many problem learners lack appropriate systems for study; a multidisciplinary educational team that is separate from the team that evaluates the success of remediation is critical. Struggling residents who require formal remediation benefit from performance improvement plans that clearly outline the issues of concern, describe the steps required for remediation, define success of remediation, and outline consequences for failure to remediate appropriately.
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Affiliation(s)
- Lilah F Morris-Wiseman
- University of Arizona, Department of Surgery, Division of Surgical Oncology, 1501 N. Campbell Avenue, PO Box 245058, Tucson, AZ 85724-5058, USA
| | - Valentine N Nfonsam
- University of Arizona, Department of Surgery, Division of Surgical Oncology, 1501 N. Campbell Avenue, PO Box 245058, Tucson, AZ 85724-5058, USA.
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To H, Cargill A, Tobin S, Nestel D. Remediation of Underperformance in Surgical Trainees - A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2021; 78:1111-1122. [PMID: 33139216 DOI: 10.1016/j.jsurg.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/14/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Surgical trainees with significant underperformance require formal support to return to an expected standard, termed remediation. The aim of this scoping review was to define remediation interventions, approaches, and contexts. DESIGN Following scoping review protocols, we set out to identify the evidence-base for remediation of surgical trainees, outline key concepts and uncover areas to stimulate further research. RESULTS From a screen of 80 articles, 24 reported on remediation of surgical trainees. Most were from medical journals (n = 21, 88%) and published in the United States (n = 20, 83%). Ten articles (41%) reported outcomes of remediation of a trainee cohort and 7 (19%) were survey reports from surgical directors. The remainder were a mix of commentaries, editorials or reviews. Thirteen articles (54%) described trainees with deficiencies in multiple competencies, 8 articles (33%) had a singular focus on academic performance, and 1 article (3%) on technical skills. All articles used targeted individualized remediation strategies, a range of intervention methods (some multimodal) and recommended a 6- to 12-month period of remediation (n = 7, 29%). The program director was often the only supervisor (n = 12, 50%). One article reported trainees' perspective of the process and one used educational theory to inform remediation. CONCLUSIONS Data with clearly reported outcomes were limited, but we found that targeted, individualized, multimodal and long-term remediation covering a range of competencies have been reported in the literature for surgical trainees. There is a need for development of explicit frameworks, strengthen the support for supervisors and trainees and further apply educational theory to develop better interventions that remediate deficiencies for all competencies.
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Affiliation(s)
- Henry To
- University of Melbourne, Parkville, Australia.
| | | | - Stephen Tobin
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Debra Nestel
- Department of Surgery (Austin), University of Melbourne, Heidelberg, Australia; Monash Institute for Health & Clinical Education, Monash University, Clayton, Australia
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Price T, Brennan N, Wong G, Withers L, Cleland J, Wanner A, Gale T, Prescott-Clements L, Archer J, Bryce M. Remediation programmes for practising doctors to restore patient safety: the RESTORE realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
An underperforming doctor puts patient safety at risk. Remediation is an intervention intended to address underperformance and return a doctor to safe practice. Used in health-care systems all over the world, it has clear implications for both patient safety and doctor retention in the workforce. However, there is limited evidence underpinning remediation programmes, particularly a lack of knowledge as to why and how a remedial intervention may work to change a doctor’s practice.
Objectives
To (1) conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety; and (2) provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors.
Design
A realist review of the literature underpinned by the Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Searches of bibliographic databases were conducted in June 2018 using the following databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Education Resources Information Center, Database of Abstracts of Reviews of Effects, Applied Social Sciences Index and Abstracts, and Health Management Information Consortium. Grey literature searches were conducted in June 2019 using the following: Google Scholar (Google Inc., Mountain View, CA, USA), OpenGrey, NHS England, North Grey Literature Collection, National Institute for Health and Care Excellence Evidence, Electronic Theses Online Service, Health Systems Evidence and Turning Research into Practice. Further relevant studies were identified via backward citation searching, searching the libraries of the core research team and through a stakeholder group.
Review methods
Realist review is a theory-orientated and explanatory approach to the synthesis of evidence that seeks to develop programme theories about how an intervention produces its effects. We developed a programme theory of remediation by convening a stakeholder group and undertaking a systematic search of the literature. We included all studies in the English language on the remediation of practising doctors, all study designs, all health-care settings and all outcome measures. We extracted relevant sections of text relating to the programme theory. Extracted data were then synthesised using a realist logic of analysis to identify context–mechanism–outcome configurations.
Results
A total of 141 records were included. Of the 141 studies included in the review, 64% related to North America and 14% were from the UK. The majority of studies (72%) were published between 2008 and 2018. A total of 33% of articles were commentaries, 30% were research papers, 25% were case studies and 12% were other types of articles. Among the research papers, 64% were quantitative, 19% were literature reviews, 14% were qualitative and 3% were mixed methods. A total of 40% of the articles were about junior doctors/residents, 31% were about practicing physicians, 17% were about a mixture of both (with some including medical students) and 12% were not applicable. A total of 40% of studies focused on remediating all areas of clinical practice, including medical knowledge, clinical skills and professionalism. A total of 27% of studies focused on professionalism only, 19% focused on knowledge and/or clinical skills and 14% did not specify. A total of 32% of studies described a remediation intervention, 16% outlined strategies for designing remediation programmes, 11% outlined remediation models and 41% were not applicable. Twenty-nine context–mechanism–outcome configurations were identified. Remediation programmes work when they develop doctors’ insight and motivation, and reinforce behaviour change. Strategies such as providing safe spaces, using advocacy to develop trust in the remediation process and carefully framing feedback create contexts in which psychological safety and professional dissonance lead to the development of insight. Involving the remediating doctor in remediation planning can provide a perceived sense of control in the process and this, alongside correcting causal attribution, goal-setting, destigmatising remediation and clarity of consequences, helps motivate doctors to change. Sustained change may be facilitated by practising new behaviours and skills and through guided reflection.
Limitations
Limitations were the low quality of included literature and limited number of UK-based studies.
Future work
Future work should use the recommendations to optimise the delivery of existing remediation programmes for doctors in the NHS.
Study registration
This study is registered as PROSPERO CRD42018088779.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Jennifer Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Amanda Wanner
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Thomas Gale
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Julian Archer
- Medicine, Nursing and Health Sciences Education Portfolio, Monash University, Melbourne, VIC, Australia
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
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7
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To H, Cargill A, Tobin S, Nestel D. Remediation for surgical trainees: recommendations from a narrative review. ANZ J Surg 2021; 91:1117-1124. [PMID: 33538072 DOI: 10.1111/ans.16637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Remediation involves formalized support for surgical trainees with significant underperformance to return to expected standards. There is a need to understand current evidence of remediation for surgical trainees to inform practice and justify investment of resources. METHODS Following the principles of a systematic review, we conducted a narrative analysis to make recommendations for remediation of underperforming surgical trainees. RESULTS From a review of 55 articles on remediation of trainees in medical and surgical sub-specialities, we have identified system and process level recommendations. Remediation is reported as long-term, complex and resource-intensive. Establishing a defined and standardized remediation framework enables co-ordination of multi-modal interventions. System level recommendations aim to consolidate protocols via developing better assessment, intervention and re-evaluation modalities whilst also strengthening support to supervisors conducting the remediation. Process level recommendations should be tailored for the specific needs of each trainee, aiming to be proactive with interventions within a programmatic framework. Regular reassessment is required, and long-term follow-up shows that remediation efforts are often successful. CONCLUSION While remediation within a programmatic framework is complex, it is often a successful approach to return surgical trainees to their expected standard. Future directions involve applying learning theories, encouraging research methods and to develop integrated collaborate protocols and support to synergize efforts.
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Affiliation(s)
- Henry To
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Ashleigh Cargill
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Stephen Tobin
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Debra Nestel
- Department of Surgery (Austin), The University of Melbourne, Melbourne, Victoria, Australia.,Monash Institute for Health and Clinical Education, Monash University, Melbourne, Victoria, Australia
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8
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Crannell WC, Brasel KJ. Dealing with the struggling learner. Surgery 2020; 167:523-527. [DOI: 10.1016/j.surg.2019.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/21/2019] [Accepted: 06/04/2019] [Indexed: 11/17/2022]
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Taira T, Santen SA, Roberts NK. Defining the "Problem Resident" and the Implications of the Unfixable Problem: The Rationale for a "Front-door" Solution. West J Emerg Med 2019; 20:43-49. [PMID: 30643600 PMCID: PMC6324719 DOI: 10.5811/westjem.2018.11.39867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/03/2018] [Accepted: 11/08/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction Problem residents are common in graduate medical education, yet little is known about their characteristics, deficits, and the consequences for emergency medicine (EM) residencies. The American Board of Internal Medicine (ABIM) defines a problem resident as “a trainee who demonstrates a significant enough problem that requires intervention by someone of authority, usually the program director [PD] or chief resident.” Although this is a comprehensive definition, it lacks specificity. Our study seeks to add granularity and nuance to the definition of “problem resident,” which can be used to guide the recruitment, selection, and training of residents. Methods We conducted semi-structured interviews with a convenience sample of EM PDs between 2011 and 2012. We performed qualitative analysis of the resulting transcripts with our thematic analysis based on the principles of grounded theory. We reached thematic sufficiency after 17 interviews. Interviews were coded as a team through consensus. Results The analysis identified diversity in the type, severity, fixability, and attribution of problems among problem residents. PDs applied a variety of thresholds to define a problem resident with many directly rejecting the ABIM definition. There was consistency in defining academic problems and some medical problems as “fixable.” In contrast, personality problems were consistently defined as “non-fixable.” Despite the diversity of the definition, there was consensus that residents who caused “turbulence” were problem residents. Conclusion The ABIM definition of the problem resident captures trainees who many PDs do not consider problem residents. We propose that an alternative definition of the problem resident would be “a resident with a negative sphere of influence beyond their personal struggle.” This combination acknowledges the identified themes of turbulence and the diversity of threshold. Further, the combination of PDs’ unwillingness to terminate trainees and the presence of non-fixable problems implies the need for a “front-door” solution that emphasizes personality issues at the potential expense of academic potential. This “front-door” solution depends on the commitment of all stakeholders including medical schools, the Association of American Medical Colleges, and PDs.
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Affiliation(s)
- Taku Taira
- LAC+USC Medical Center, Department of Emergency Medicine, Los Angeles, California.,Stony Brook University Medical Center, Department of Emergency Medicine, Stony Brook, New York
| | - Sally A Santen
- Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, Virginia
| | - Nicole K Roberts
- The City University of New York (CUNY) School of Medicine, Department of Medical Education, New York, New York
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11
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Raman HS, Limbrick DD, Ray WZ, Coble DW, Church S, Dacey RG, Zipfel GJ. Prevalence, management, and outcome of problem residents among neurosurgical training programs in the United States. J Neurosurg 2019; 130:322-326. [PMID: 29498572 DOI: 10.3171/2017.8.jns171719] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/28/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE: The challenging nature of neurosurgical residency necessitates that appropriate measures are taken by training programs to ensure that residents are properly progressing through their education. Residents who display a pattern of performance deficiencies must be identified and promptly addressed by faculty and program directors to ensure that resident training and patient care are not affected. While studies have been conducted to characterize these so-called "problem residents" in other specialties, no current data regarding the prevalence and management of such residents in neurosurgery exist. The purpose of this study was to determine the rate and the outcome of problem residents in US neurosurgical residency programs and identify predictive risk factors that portend a resident's departure from the program. METHODS: An anonymous nationwide survey was sent to all 108 neurosurgical training programs in the US to assess a 20-year history of overall attrition as well as the management course of problem residents, including the specific deficiencies of the resident, management strategies used by faculty, and the eventual outcome of each resident's training. RESULTS: Responses were received from 36 centers covering a total of 1573 residents, with the programs providing a mean 17.4 years' worth of data (95% CI 15.3-19.4 years). The mean prevalence of problem residents among training programs was 18.1% (95% CI 14.7%-21.6%). The most common deficiencies recognized by program directors were poor communication skills (59.9%), inefficiency in tasks (40.1%), and poor fund of medical knowledge (39.1%). The most common forms of program intervention were additional meetings to provide detailed feedback (93.9%), verbal warnings (78.7%), and formal written remediation plans (61.4%). Of the identified problem residents whose training status is known, 50% graduated or are on track to graduate, while the remaining 50% ultimately left their residency program for other endeavors. Of the 97 residents who departed their programs, 65% left voluntarily (most commonly for another specialty), and 35% were terminated (often ultimately training in another neurosurgery program). On multivariable logistic regression analysis, the following 3 factors were independently associated with departure of a problem resident from their residency program: dishonesty (OR 3.23, 95% CI 1.67-6.253), poor fund of medical knowledge (OR 2.54, 95% CI 1.47-4.40), and poor technical skill (OR 2.37, 95% CI 1.37-4.12). CONCLUSIONS: The authors' findings represent the first study to characterize the nature of problem residents within neurosurgery. Identification of predictive risk factors, such as dishonesty, poor medical knowledge, and/or technical skill, may enable program directors to preemptively act and address such deficiencies in residents before departure from the program occurs. As half of the problem residents departed their programs, there remains an unmet need for further research regarding effective remediation strategies.
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12
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de Leon J, Wise TN, Balon R, Fava GA. Dealing with Difficult Medical Colleagues. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:5-11. [PMID: 29306944 DOI: 10.1159/000481200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 09/03/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
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13
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Thaxton RE, Jones WS, Hafferty FW, April CW, April MD. Self vs. Other Focus: Predicting Professionalism Remediation of Emergency Medicine Residents. West J Emerg Med 2018; 19:35-40. [PMID: 29383054 PMCID: PMC5785199 DOI: 10.5811/westjem.2017.11.35242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/09/2017] [Accepted: 11/13/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Unprofessionalism is a major reason for resident dismissal from training. Because of the high stakes involved, residents and educators alike would benefit from information predicting whether they might experience challenges related to this competency. Our objective was to correlate the outcome of professionalism-related remedial actions during residency with the predictor variable of resident response to a standardized interview question: “Why is Medicine important to you?” Methods We conducted a professional development quality improvement (QI) initiative to improve resident education and mentorship by achieving a better understanding of each resident’s reasons for valuing a career in medicine. This initiative entailed an interview administered to each resident beginning emergency medicine training at San Antonio Military Medical Center during 2006–2013. The interviews uniformly began with the standardized question “Why is Medicine important to you?” The residency program director documented a free-text summary of each response to this question, the accuracy of which was confirmed by the resident. We analyzed the text of each resident’s response after a review of the QI data suggested an association between responses and professionalism actions (retrospective cohort design). Two associate investigators blinded to all interview data, remedial actions, and resident identities categorized each text response as either self-focused (e.g., “I enjoy the challenge”) or other-focused (e.g., “I enjoy helping patients”). Additional de-identified data collected included demographics, and expressed personal importance of politics and religion. The primary outcome was a Clinical Competency Committee professionalism remedial action. Results Of 114 physicians starting residency during 2006–2013, 106 (93.0%) completed the interview. There was good inter-rater reliability in associate investigator categorization of resident responses as either self-focused or other-focused (kappa coefficient 0.85). Thirteen of 50 residents (26.0%) expressed self-focus versus three of 54 (5.4%) residents expressed other-focus experienced professionalism remedial actions (p<0.01). This association held in a logistic regression model controlling for measured confounders (p=0.02). Conclusion Self-focused responses to the question “Why is Medicine important to you?” correlated with professionalism remedial actions during residency.
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Affiliation(s)
- Robert E Thaxton
- San Antonio Uniformed Services Health Education Consortium, Department of Emergency Medicine, San Antonio, Texas
| | - Woodson S Jones
- San Antonio Uniformed Services Health Education Consortium, Department of Graduate Medical Education, San Antonio, Texas
| | - Fred W Hafferty
- University of Minnesota Medical School, Department of Behavioral Sciences, Minneapolis, Minnesota
| | - Carolyn W April
- University of Texas Health Sciences Center San Antonio, Department of Medicine, San Antonio Texas
| | - Michael D April
- San Antonio Uniformed Services Health Education Consortium, Department of Emergency Medicine, San Antonio, Texas
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Williams BW, Flanders P, Grace ES, Korinek E, Welindt D, Williams MV. Assessment of fitness for duty of underperforming physicians: The importance of using appropriate norms. PLoS One 2017; 12:e0186902. [PMID: 29053736 PMCID: PMC5650180 DOI: 10.1371/journal.pone.0186902] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 10/10/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To determine whether population-specific normative data should be employed when screening neurocognitive functioning as part of physician fitness for duty evaluations. If so, to provide such norms based on the evidence currently available. Methods A comparison of published data from four sources was analyzed. Data from the two physician samples were then entered into a meta-analysis to obtain full information estimates and generate provisional norms for physicians. Results Two-way analysis of variance (Study x Index) revealed a significant main effect and an interaction. Results indicate differences in mean levels of performance and standard deviation for physicians. Conclusions Reliance on general population normative data results in under-identification of potential neuropsychological difficulties. Population specific normative data are needed to effectively evaluate practicing physicians.
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Affiliation(s)
- Betsy White Williams
- Department of Psychiatry School of Medicine, University of Kansas, Clinical Program, Kansas City, Kansas, United States of America
- Professional Renewal Center® (PRC®), Lawrence, Kansas, United States of America
- * E-mail:
| | - Philip Flanders
- Professional Renewal Center® (PRC®), Lawrence, Kansas, United States of America
| | - Elizabeth S. Grace
- Center for Personalized Education for Physicians (CPEP), Denver, Colorado, United States of America
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Elizabeth Korinek
- Center for Personalized Education for Physicians (CPEP), Denver, Colorado, United States of America
| | - Dillon Welindt
- Wales Behavioral Assessment (WBA), Lawrence, Kansas, United States of America
| | - Michael V. Williams
- Wales Behavioral Assessment (WBA), Lawrence, Kansas, United States of America
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Chang HJ, Lee YM, Lee YH, Kwon HJ. Causes of resident lapses in professional conduct during the training: A qualitative study on the perspectives of residents. MEDICAL TEACHER 2017; 39:278-284. [PMID: 28019136 DOI: 10.1080/0142159x.2017.1270432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The residency is a critical period for doctors to establish their professional identity and ethical standards, and yet during this time, residents are susceptible to engage in a diverse range of unprofessional behaviors. To prevent the misconduct of residents, it is critical to have a thorough understanding of the contributing factors or circumstances. METHODS We conducted a qualitative study on 20 residents at one Korean university-affiliated tertiary hospital. During in-depth interviews, residents were asked to reveal their experiences or observations of misconduct, and describe their perceptions on the attributes of professional lapses. RESULTS Diverse unethical and unprofessional behaviors were extracted from the transcripts and reported in a previous paper. In the current paper, the attributes that residents regarded as the causes of their unprofessional behaviors were identified within four categories: (1) inadequate systems within training hospitals; (2) lack of professionalism education; (3) strong hierarchical structure; and (4) poor character of individuals. The residents tended to perceive their misconduct as situation-sensitive, and emphasized the importance of systematic and cultural changes. CONCLUSIONS To enhance medical professionalism among residents, the results of this study suggest the need of systematic and structured training programs, adequate professionalism education with clear codes of conduct, and active monitoring and feedback systems.
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Affiliation(s)
- Hyung-Joo Chang
- a Department of Medical Humanities , Korea University College of Medicine , Seoul , Korea
| | - Young-Mee Lee
- a Department of Medical Humanities , Korea University College of Medicine , Seoul , Korea
| | - Young-Hee Lee
- a Department of Medical Humanities , Korea University College of Medicine , Seoul , Korea
| | - Hyo-Jin Kwon
- a Department of Medical Humanities , Korea University College of Medicine , Seoul , Korea
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Sparks JW, Landrigan-Ossar M, Vinson A, Dearden J, Navedo AT, Waisel DB, Holzman RS. Individualized remediation during fellowship training. J Clin Anesth 2016; 34:452-8. [DOI: 10.1016/j.jclinane.2016.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/13/2016] [Indexed: 11/28/2022]
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Lazarus JL, Hosseini M, Kamangar F, Levien DH, Rowland PA, Kowdley GC, Cunningham SC. Verbal Aggressiveness Among Physicians and Trainees. JOURNAL OF SURGICAL EDUCATION 2016; 73:756-760. [PMID: 27137669 DOI: 10.1016/j.jsurg.2016.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To better understand verbal aggressiveness among physicians and trainees, including specialty-specific differences. DESIGN AND PARTICIPANTS The Infante Verbal Aggressiveness Scale (IVAS) was administered as part of a survey to 48 medical students, 24 residents, and 257 attending physicians. The 72 trainees received the IVAS and demographic questions, whereas the attending physicians received additional questions regarding type of practice, career satisfaction, litigation, and personality type. RESULTS The IVAS scores showed high reliability (Cronbach α = 0.83). Among all trainees, 56% were female with mean age 28 years, whereas among attending physicians, 63% were male with mean age 50 years. Average scores of trainees were higher than attending physicians with corresponding averages of 1.88 and 1.68, respectively. Among trainees, higher IVAS scores were significantly associated with male sex, non-US birthplace, choice of surgery, and a history of bullying. Among attending physicians, higher IVAS scores were significantly associated with male sex, younger age, self-reported low-quality of patient-physician relationships, and low enjoyment talking to patients. General surgery and general internal medicine physicians were significantly associated with higher IVAS scores than other specialties. General practitioners (surgeons and medical physicians) had higher IVAS scores than the specialists in their corresponding fields. No significant correlation was found between IVAS scores and threats of legal action against attending physicians, or most personality traits. Additional findings regarding bullying in medical school, physician-patient interactions, and having a method to deal with inappropriate behavior at work were observed. CONCLUSIONS Individuals choosing general specialties display more aggressive verbal communication styles, general surgeons displaying the highest. The IVAS scoring system may identify subgroups of physicians with overly aggressive (problematic) communication skills and may provide a backdrop for educating physician communicators. The relationship between verbal aggressiveness and efficacy of clinical communication merits inquiry.
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Affiliation(s)
| | - Motahar Hosseini
- Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland
| | - Farin Kamangar
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland
| | - David H Levien
- Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland
| | - Pamela A Rowland
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gopal C Kowdley
- Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
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Davis LE, Miller ML, Raub JN, Gortney JS. Constructive ways to prevent, identify, and remediate deficiencies of "challenging trainees" in experiential education. Am J Health Syst Pharm 2016; 73:996-1009. [PMID: 27325881 DOI: 10.2146/ajhp150330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Lindsay E Davis
- College of Pharmacy-Glendale, Midwestern University, Glendale, AZBanner Estrella Medical Center, Phoenix, AZ
| | | | | | - Justine S Gortney
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI.
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Christensen MK, O’Neill L, Hansen DH, Norberg K, Mortensen LS, Charles P. Residents in difficulty: a mixed methods study on the prevalence, characteristics, and sociocultural challenges from the perspective of residency program directors. BMC MEDICAL EDUCATION 2016; 16:69. [PMID: 26907611 PMCID: PMC4763408 DOI: 10.1186/s12909-016-0596-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
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.
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Affiliation(s)
- Mette K. Christensen
- />Centre for Health Sciences Education, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Lotte O’Neill
- />Centre for Health Sciences Education, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Dorthe H. Hansen
- />Centre for Health Sciences Education, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Karen Norberg
- />Northern Postgraduate Medical Training Region Secretariat, Skottenborg 26, 8800 Viborg, Denmark
| | | | - Peder Charles
- />Centre for Health Sciences Education, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
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Domen RE, Talbert ML, Johnson K, Post MD, Brissette MD, Conran RM, Hoffman RD, McCloskey CB, Raciti PM, Roberts CA, Rojiani AM, Tucker JA, Powell SZE. Assessment and Management of Professionalism Issues in Pathology Residency Training: Results From Surveys and a Workshop by the Graduate Medical Education Committee of the College of American Pathologists. Acad Pathol 2015; 2:2374289515592887. [PMID: 28725747 PMCID: PMC5479457 DOI: 10.1177/2374289515592887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Professionalism issues are common in residency training and can be very difficult to recognize and manage. Almost one-third of the milestones for pathology recently instituted by the Accreditation Council for Graduate Medical Education encompass aspects of professionalism. Program directors are often unsure of how and when to remediate residents for unprofessional behavior. We used a case-based educational approach in a workshop setting to assist program directors in the management of unprofessional behavior in residents. Eight case scenarios highlighting various aspects of unprofessional behavior by pathology residents were developed and presented in an open workshop forum at the annual pathology program director’s meeting. Prior to the workshop, 2 surveys were conducted: (1) to collect data on program directors’ experience with identifying, assessing, and managing unprofessional behavior in their residents and (2) to get feedback from workshop registrants on how they would manage each of the 8 case scenarios. A wide range of unprofessional behaviors have been observed by pathology program directors. Although there is occasionally general agreement on how to manage specific behaviors, there remains wide variation in how to manage many of the presented unprofessional behaviors. Remediation for unprofessional behavior in pathology residents remains a difficult and challenging process. Additional education and research in this area are warranted.
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Affiliation(s)
- Ronald E Domen
- Division of Laboratory Medicine, Department of Pathology, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, USA
| | - Michael L Talbert
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Miriam D Post
- Department of Pathology, Anschutz Medical Campus, University of Colorado-Denver, Aurora, CO, USA
| | | | | | - Robert D Hoffman
- Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Cindy B McCloskey
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Patricia M Raciti
- Department of Pathology and Cell Biology, Columbia University Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | | | - Amyn M Rojiani
- Department of Pathology, Georgia Regents University, Augusta, GA, USA
| | - J Allan Tucker
- Department of Pathology, University of South Alabama, Mobile, AL, USA
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22
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Rougas S, Gentilesco B, Green E, Flores L. Twelve tips for addressing medical student and resident physician lapses in professionalism. MEDICAL TEACHER 2015; 37:901-907. [PMID: 25665630 DOI: 10.3109/0142159x.2014.1001730] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Medical educators have gained significant ground in the practical and scholarly approach to professionalism. When a lapse occurs, thoughtful remediation to address the underlying issue can have a positive impact on medical students and resident physicians, while failure to address lapses, or to do so ineffectively, can have long-term consequences for learners and potentially patients. Despite these high stakes, educators are often hesitant to address lapses in professionalism, possibly due to a lack of time and familiarity with the process. Attention must be paid to generalizable, hands-on recommendations for daily use so that clinicians and administrators feel well equipped to tackle this often difficult yet valuable task. This article reviews the literature related to addressing unprofessional behavior among trainees in medicine and connects it to the shared experience of medical educators at one institution. The framework presented aims to provide practical guidance and empowerment for educators responsible for addressing medical student and resident physician lapses in professionalism.
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Affiliation(s)
- Steven Rougas
- a The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Bethany Gentilesco
- a The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Emily Green
- a The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Libertad Flores
- a The Warren Alpert Medical School of Brown University , Providence , RI , USA
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Minter RM, Dunnington GL, Sudan R, Terhune KP, Dent DL, Lentz AK. Can This Resident Be Saved? Identification and Early Intervention for Struggling Residents. J Am Coll Surg 2014; 219:1088-95. [DOI: 10.1016/j.jamcollsurg.2014.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
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Badran KW, Kelley K, Conderman C, Mahboubi H, Armstrong WB, Bhandarkar ND. Improving applicant selection: Identifying qualities of the unsuccessful otolaryngology resident. Laryngoscope 2014; 125:842-7. [DOI: 10.1002/lary.24860] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 07/02/2014] [Accepted: 07/07/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Karam W. Badran
- Department of Otolaryngology-Head and Neck Surgery; University of California-Irvine; Irvine California U.S.A
| | - Kanwar Kelley
- Department of Otolaryngology-Head and Neck Surgery; University of California-Irvine; Irvine California U.S.A
| | - Christian Conderman
- Department of Otolaryngology-Head and Neck Surgery; University of California-Irvine; Irvine California U.S.A
| | - Hossein Mahboubi
- Department of Otolaryngology-Head and Neck Surgery; University of California-Irvine; Irvine California U.S.A
| | - William B. Armstrong
- Department of Otolaryngology-Head and Neck Surgery; University of California-Irvine; Irvine California U.S.A
| | - Naveen D. Bhandarkar
- Department of Otolaryngology-Head and Neck Surgery; University of California-Irvine; Irvine California U.S.A
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Abstract
BACKGROUND The patient safety imperative has raised expectations regarding the responsibility of medical educators and decision makers to ensure that physicians are competent. Ensuring that trainees are ready for independent practice upon graduation is challenged by reduced work hours such that trainees spend less time in the OR and perform fewer cases than desirable. METHODS The literature on the assessment of technical and non--technical operative skills and professionalism was reviewed in order to make recommendations to identify barriers to evaluation. DISCUSSION Barriers to documenting performance deficiencies include uncertainty as to what should be documented, and concerns about the negative impact of critical evaluations on faculty popularity. Additional challenges include a lack of clear standards for performance and effective remediation options. CONCLUSIONS Trainee performance should be evaluated in a rigorous, reliable and meaningful way to ensure that graduates have the skills necessary for safe, independent practice.
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Cochran A, Elder WB. A model of disruptive surgeon behavior in the perioperative environment. J Am Coll Surg 2014; 219:390-8. [PMID: 25067803 DOI: 10.1016/j.jamcollsurg.2014.05.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/08/2014] [Accepted: 05/28/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgeons are the physicians with the highest rates of documented disruptive behavior. We hypothesized that a unified conceptual model of disruptive surgeon behavior could be developed based on specific individual and system factors in the perioperative environment. STUDY DESIGN Semi-structured interviews were conducted with 19 operating room staff of diverse occupations at a single institution. Interviews were analyzed using grounded theory methods. RESULTS Participants described episodes of disruptive surgeon behavior, personality traits of perpetrators, environmental conditions of power, and situations when disruptive behavior was demonstrated. Verbal hostility and throwing or hitting objects were the most commonly described disruptive behaviors. Participants indicated that surgical training attracts and creates individuals with particular personality traits, including a sense of shame. Interviewees stated this behavior is tolerated because surgeons have unchecked power, have strong money-making capabilities for the institution, and tend to direct disruptive behavior toward the least powerful employees. The most frequent situational stressors were when something went wrong during an operation and working with unfamiliar team members. Each factor group (ie, situational stressors, cultural conditions, and personality factors) was viewed as being necessary, but none of them alone were sufficient to catalyze disruptive behavior events. CONCLUSIONS Disruptive physician behavior has strong implications for the work environment and patient safety. This model can be used by hospitals to better conceptualize conditions that facilitate disruptive surgeon behavior and to establish programs to mitigate conduct that threatens patient safety and employee satisfaction.
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Affiliation(s)
- Amalia Cochran
- University of Utah Department of Surgery, Salt Lake City, UT.
| | - William B Elder
- University of Utah Department of Surgery, Salt Lake City, UT
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Domen RE. Resident remediation, probation, and dismissal basic considerations for program directors. Am J Clin Pathol 2014; 141:784-90. [PMID: 24838321 DOI: 10.1309/ajcpsnpap5r5nhus] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To suggest a basic new approach for pathology training programs to consider when a resident requires remediation, probation, or dismissal. METHODS Remediation, probation, or dismissal of the poorly performing pathology resident is one of the most difficult and challenging aspects of any pathology training program. The poorly performing resident requires extra time and resources from the faculty and the program and can be disruptive for the entire program. Effective remediation requires faculty development, a well-constructed remediation or probation plan, and documentation. RESULTS Despite best efforts, not all remediation plans are successful and dismissal of the resident will need to be seriously considered. CONCLUSIONS Approaches to dealing with resident performance issues can be variable and need to be tailored to the issue being addressed.
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Affiliation(s)
- Ronald E. Domen
- Department of Pathology and Laboratory Medicine, Penn State Hershey Medical Center and College of Medicine, Hershey, PA
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Nagler A, Andolsek K, Rudd M, Sloane R, Musick D, Basnight L. The professionalism disconnect: do entering residents identify yet participate in unprofessional behaviors? BMC MEDICAL EDUCATION 2014; 14:60. [PMID: 24674275 PMCID: PMC3974201 DOI: 10.1186/1472-6920-14-60] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 03/14/2014] [Indexed: 05/17/2023]
Abstract
BACKGROUND Professionalism has been an important tenet of medical education, yet defining it is a challenge. Perceptions of professional behavior may vary by individual, medical specialty, demographic group and institution. Understanding these differences should help institutions better clarify professionalism expectations and provide standards with which to evaluate resident behavior. METHODS Duke University Hospital and Vidant Medical Center/East Carolina University surveyed entering PGY1 residents. Residents were queried on two issues: their perception of the professionalism of 46 specific behaviors related to training and patient care; and their own participation in those specified behaviors. The study reports data analyses for gender and institution based upon survey results in 2009 and 2010. The study received approval by the Institutional Review Boards of both institutions. RESULTS 76% (375) of 495 PGY1 residents surveyed in 2009 and 2010 responded. A majority of responders rated all 46 specified behaviors as unprofessional, and a majority had either observed or participated in each behavior. For all 46 behaviors, a greater percentage of women rated the behaviors as unprofessional. Men were more likely than women to have participated in behaviors. There were several significant differences in both the perceptions of specified behaviors and in self-reported observation of and/or involvement in those behaviors between institutions.Respondents indicated the most important professionalism issues relevant to medical practice include: respect for colleagues/patients, relationships with pharmaceutical companies, balancing home/work life, and admitting mistakes. They reported that professionalism can best be assessed by peers, patients, observation of non-medical work and timeliness/detail of paperwork. CONCLUSION Defining professionalism in measurable terms is a challenge yet critical in order for it to be taught and assessed. Recognition of the differences by gender and institution should allow for tailored teaching and assessment of professionalism so that it is most meaningful. A shared understanding of what constitutes professional behavior is an important first step.
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Affiliation(s)
- Alisa Nagler
- Duke University Hospital – Graduate Medical Education, PO Box 3951, DUMC, Durham, NC, USA
| | - Kathryn Andolsek
- Duke University Hospital – Graduate Medical Education, PO Box 3951, DUMC, Durham, NC, USA
| | - Mariah Rudd
- Duke University Hospital – Graduate Medical Education, PO Box 3951, DUMC, Durham, NC, USA
| | - Richard Sloane
- Duke University Hospital, Center for the Study of Aging and Human Development, Durham, NC, USA
- Duke University Hospital – Graduate Medical Education, PO Box 3951, DUMC, Durham, NC, USA
| | - David Musick
- Office of Medical Education, Vidant Medical Center/East Carolina University, Greenville, USA
| | - Lorraine Basnight
- Office of Medical Education, Vidant Medical Center/East Carolina University, Greenville, USA
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Recognizing Residents with a Deficiency in Operative Performance as a Step Closer to Effective Remediation. J Am Coll Surg 2013; 216:114-22. [DOI: 10.1016/j.jamcollsurg.2012.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 09/12/2012] [Accepted: 09/12/2012] [Indexed: 12/25/2022]
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