Health concerns, personal problems and underperformance in General Practice Registrars

Abstract

Background: Early identification and management of underperformance is repeatedly highlighted in the remediation literature as being important and inadequately addressed health issues have often been found to underlie the overt clinical skills concern. Because of the prevalence of burnout, many studies emphasise the need for doctors generally to better attend to self-care and for the wider availability of supportive programs that promote resilience and prevent burnout. The literature however, is limited on how doctors, let alone general practice registrars, with health concerns may be identified and once identified, how they should be managed. Method: This paper reflects on the experiences of a team of medical educators responsible for the management of underperforming registrars in a General Practice training program over a 10-year period, from 2006 to 2015. Data is presented showing the incidence of health concerns and personal problems affecting registrars who came to the attention of the medical educators managing remediation for that period. The paper also reflects on the processes that were developed for identifying and managing those registrars. Results: Over the 10-year period, the incidence of health concerns and personal problems, and particularly anxiety related issues, increased while clinical skills concerns declined. A significant finding was that health concerns and personal problems impacted on clinical skills and the converse was also observed. Furthermore, unless identified health concerns and personal problems were addressed, any existing clinical skills concerns were not easily resolved. As processes improved, health concerns and personal problems were more readily identified and addressed, sometimes even before clinical skills concerns arose. Conclusions: This study has provided insight into the nature of the health concerns and personal problems that general practice registrars contend with and highlights the importance of addressing those issues alongside any clinical skills issues in the interests of registrar wellbeing and patient safety.