Residents in difficulty: a mixed methods study on the prevalence, characteristics, and sociocultural challenges from the perspective of residency program directors

Abstract

BackgroundThe 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.MethodsWe 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 (Χ2) 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.Results73.2 % 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.ConclusionsMore 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.

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

“…The remediation rate of 4.3% in our cohort is consistent with literature reported values of 2% to 9%. [1][2][3][4][5][6] Further, the demographics of the residents in this study (Table 1) are comparable to other family medicine residency programs in Canada (see annual reports from the Canadian Post-MD Education Registry, www.caper.ca/ en/post-graduate-medical-education/ annual-census). Finally, family medicine residency training in Canada is accredited by the College of Family Physicians of Canada, and is relatively consistent across Canada in terms of the clinical rotations and experiences that are offered.…”

Challenges to neurology residency education in today's health care environment

“…17 For some residents, never being given the opportunity to make decisions may lead to difficulty. This is a particular struggle in neurology, where, for many diseases, an aging population is confronted with a lack of disease-modifying treatment options, and where a typical patient evaluation and examination can take an hour or more.…”

“…Christensen et al interviewed residency directors and found that sociocultural problems like inadequate feedback and perceived priority of efficient patient care before education may explain why some residents have difficulty. 17 For some residents, never being given the opportunity to make decisions may lead to difficulty. Despite all of the increasing demands on the health care system, public expectations for professionalism and quality are at an all-time high.…”

The Swansea 6D model: a diagnostic and conversational framework for supervisors, mentors and doctors in training

“…The warning signs of a doctor in difficulty [27][28][29][30]. Exhibits frequent mood swings, such as irritability or being easily moved to anger or tears in challenging situations.Lacking in insightRejection, becoming defensive, or responding poorly to constructive feedback on performance, lack of ability to reflect on situations.…”