“Problem Residents”: Prevalence, Problems and Remediation in the Era of Core Competencies

Describing Failure in a Clinical Clerkship: Implications for Identification, Assessment and Remediation for Struggling Learners

“…Critical deficiencies were identified in all competency domains, however, we found higher concentrations of deficiencies in KP (98 % of students), ICS (91 %), and Patient Care (PC; 88 %), which is consistent with previous studies of struggling internal medicine residents and medical students. 6,7,22 The most common critical deficiencies were Binsufficient knowledge( 79 %), Binadequate patient presentation skills^(74 %), and Binadequate ability to create a plan^(60 %). This suggests that failing students are struggling with the core areas of fund of knowledge, the ability to synthesize and apply their knowledge, and the ability to clearly communicate their knowledge and synthesis during rounds.…”

“…6 These struggling learners are most likely to be identified on inpatient rotations, but little has been written about the specific behaviors exhibited by students that lead to their failure. 7,8 A better understanding of the types of deficits leading to failure and the development of robust remediation protocols for these areas may improve the success of learner remediation. Unfortunately, failing performance is often identified late, 9 and remediation involves simply having the student do more of the same types of experiences.…”

« Ils sont carrément incurables » : comment les métaphores des cliniciens enseignants révèlent leur malaise dans la gestion des difficultés de raisonnement clinique de leurs internes

“…La littérature s'accorde à reconnaitre l'importance de mettre en oeuvre des processus de remédiations de telles difficultés [6][7][8][9] . On souligne notamment l'importance d'identifier les difficultés rapidement, de poser un diagnostic pédago-gique de ces difficultés, d'en identifier la source ou les causes, enfin de mettre en oeuvre un plan de remé-diation et de suivi, à la fois personnalisé et spécifique, des difficultés identifiées [8][9][10][11][12] .…”

“…Force est de constater cependant que ces processus sont relativement difficiles à implanter dans la réalité du contexte clinique [6] . Les raisons sont d'abord liées au contexte lui-même, avec ses aléas, qui ne favorisent pas une démarche structurée et planifiée de gestion des difficultés [14] .…”

Describing Failure in a Clinical Clerkship

“…The authors categorized deficiencies using the domains of the Physician Competencies Reference Set 2 designed by the American Association of Medical Colleges, which included medical knowledge, patient care, practice-based learning and improving, interpersonal and communication skills, professionalism, systems-based practice, inter-professional collaboration, and personalprofessional development. Surveys of residency program directors 3 frequently cite organization and efficiency as concerning deficiencies in residents, while this topic is largely overlooked in medical students. There is a perception that because medical students are just learning how to assess patients that organization and efficiency are skills that will just be obtained with more experience.…”