Advertisement

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

      The American Board of Internal Medicine (ABIM) has defined the “problem resident” as a learner who demonstrates problem behaviors significant enough to require intervention by program leadership, typically the residency program director or chief resident.
      American Board of Internal Medicine. Chief Residents' Workshop on Problem Residents. Association of Program Directors in Internal Medicine (APDIM)
      It has been over a decade since Yao and Wright's report
      • Yao D.C.
      • Wright S.M.
      National survey of internal medicine residency program directors regarding problem residents.
      on the prevalence of “problem residents” in internal medicine residency training programs. Their survey of program directors reported performance problems in 6.9% of residents. We are unaware of any subsequent large studies in internal medicine of this important topic. Although the term “problem resident” has been used frequently, we will refer to these individuals as “residents in difficulty.”
      • Reamy B.V.
      • Harman J.H.
      Residents in trouble: an in-depth assessment of the 25-year experience of a single family medicine residency.
      The purpose of this study was to assess internal medicine program director experiences with residents in difficulty in the era of Accreditation Council for Graduate Medical Education (ACGME) competencies.
      Accreditation Council of Graduate Medical Education
      Common Program Reqiurements: General Competencies.
      • Internal medicine residents requiring remediation often have deficiencies in multiple competencies.
      • Deficiencies were identified in all competencies; remediation is most successful for medical knowledge (85.8%) and least successful for professionalism (41.2%).
      • Application materials rarely help program directors identify individuals at risk for difficulty during residency.
      • Performance deficiencies were rarely (5.6%) self-identified by residents.
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American Board of Internal Medicine. Chief Residents' Workshop on Problem Residents. Association of Program Directors in Internal Medicine (APDIM)
        April 19, 1999 (New Orleans, LA)
        • Yao D.C.
        • Wright S.M.
        National survey of internal medicine residency program directors regarding problem residents.
        JAMA. 2000; 284: 1099-1104
        • Reamy B.V.
        • Harman J.H.
        Residents in trouble: an in-depth assessment of the 25-year experience of a single family medicine residency.
        Fam Med. 2006; 38: 252-257
        • Accreditation Council of Graduate Medical Education
        Common Program Reqiurements: General Competencies.
        ([cited 2011 August, 23]) (Accessed December 1, 2008)
        • Loertshcer L.L.
        • Halvorsen A.J.
        • Beasley B.W.
        • et al.
        Pharmaceutical industry support and residency education: a survey of internal medicine program directors.
        Arch Intern Med. 2010; 170: 356-362
        • Singh D.
        • McDonald F.S.
        • Beasley B.W.
        Demographic and work-life study of chief residents: a survey of the program directors in internal medicine residency programs in the United States.
        J Grad Med Educ. 2009; 1: 150-154
      1. List of programs by specialty—internal medicine [database on the Internet].
        ([cited December 1, 2008]) (Accessed January 21, 2012)
        • Halvorsen A.J.
        APDIM 2008 Survey.
        2010 ([cited 2011 August 23]) (Accessed December 1, 2008)
      2. Census regions and divisions of the United States [database on the Internet].
        ([cited December 1, 2008]) (Accessed December 1, 2008)
      3. Graduate medical education: FREIDA Online [database on the Internet].
        ([cited December 1, 2008]) (Accessed January 21, 2012)
      4. Residency program pass rates 2006-2009 [database on the Internet].
        ([cited December 1, 2008]) (Accessed December 1, 2008)
      5. Accredited programs—internal medicine [database on the Internet].
        ([cited December 1, 2008]) (Accessed January 21, 2012)
        • American Board of Internal Medicine
        FasTrack.
        ([cited 2011 August 23]) American Board of Internal Medicine, Philadelphia2010 (Accessed December 1, 2008)
        • Bergen P.C.
        • Littlefield J.H.
        • O'Keefe G.E.
        • et al.
        Identification of high-risk residents.
        J Surg Res. 2000; 92: 239-244
        • Resnick A.S.
        • Mullen J.L.
        • Kaiser L.R.
        • Morris J.B.
        Patterns and predictions of resident misbehavior—a 10-year retrospective look.
        Curr Surg. 2006; 63: 418-425
        • Williams R.G.
        • Roberts N.K.
        • Schwind C.J.
        • Dunnington G.L.
        The nature of general surgery resident performance problems.
        Surgery. 2009; 145: 651-658
        • Adams K.E.
        • Emmons S.
        • Romm J.
        How resident unprofessional behavior is identified and managed: a program director survey.
        Am J Obstet Gynecol. 2008; 198 (e1-5): 692
        • Hauer K.E.
        • Ciccone A.
        • Henzel T.R.
        • et al.
        Remediation of the deficiencies of physicians across the continuum from medical school to practice: a thematic review of the literature.
        Acad Med. 2009; 84: 1822-1832
        • Papadakis M.A.
        • Arnold G.K.
        • Blank L.L.
        • et al.
        Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards.
        Ann Intern Med. 2008; 148: 869-876
        • Papadakis M.A.
        • Hodgson C.S.
        • Teherani A.
        • Kohatsu N.D.
        Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board.
        Acad Med. 2004; 79: 244-249
        • Davis D.A.
        • Mazmanian P.E.
        • Fordis M.
        • et al.
        Accuracy of physician self-assessment compared with observed measures of competence: a systematic review.
        JAMA. 2006; 296: 1094-1102
        • Kruger J.
        • Dunning D.
        Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments.
        J Pers Soc Psychol. 1999; 77: 1121-1134
        • Holmboe E.S.
        • Hawkins R.E.
        Methods for evaluating the clinical competence of residents in internal medicine: a review.
        Ann Intern Med. 1998; 129: 42-48
        • Torbeck L.
        • Canal D.F.
        Remediation practices for surgery residents.
        Am J Surg. 2009; 197: 397-402
        • Ferguson E.
        • James D.
        • Madeley L.
        Factors associated with success in medical school: systematic review of the literature.
        BMJ. 2002; 324: 952-957
        • Wagoner N.E.
        • Suriano J.R.
        A new approach to standardizing the dean's letter.
        Acad Med. 1989; 64: 688-689
        • Lurie S.J.
        • Lambert D.R.
        • Grady-Weliky T.A.
        Relationship between dean's letter rankings and later evaluations by residency program directors.
        Teach Learn Med. 2007; 19: 251-256
        • Cullen M.W.
        • Reed D.A.
        • Halvorsen A.J.
        • et al.
        Selection criteria for internal medicine residency applicants and professionalism ratings during internship.
        Mayo Clin Proc. 2011; 86: 197-202
        • Brenner A.M.
        • Mathai S.
        • Jain S.
        • Mohl P.C.
        Can we predict “problem residents”?.
        Acad Med. 2010; 85: 1147-1151
        • Edson R.S.
        • Beckman T.J.
        • West C.P.
        • et al.
        A multi-institutional survey of internal medicine residents' learning habits.
        Med Teach. 2010; 32: 773-775
        • Tabby D.S.
        • Majeed M.H.
        • Schwartzman R.J.
        Problem neurology residents: a national survey.
        Neurology. 2011; 76: 2119-2123