The nature of general surgery resident performance problems

Reed G. Williams, Nicole K. Roberts, Cathy J. Schwind, Gary Dunnington

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: Residents with performance problems are challenging to program directors and complicate the work of other residents and health care providers. Having an effective, targeted remediation process to address these problems is dependent on being able to diagnose their nature. The purpose of this study was to identify residents who had serious, substantive, and recurring academic, clinical, and/or professional behavior problems, and to describe and classify their nature. Methods: Raters performed a retrospective record review of general surgery categorical residents in one program over 30 years. Residents with substantial problems were reviewed, described, and classified independently by 3 raters. Results: Seventeen residents had serious enough performance problems to be included. Four had only 1 class of problem (3 were professional behavior problems). Eight residents had 2 problems each (5 academic and clinical performance problems; 3 clinical performance and professional behavior problems). Five residents had 3 problems. The number of performance problem facets per case varied from 11 to 2 with an average of 5.9 facets. Relations with health care workers was identified most frequently, followed closely by insufficient knowledge. Poor communication was third. Performance problems of 14 residents (82%) were identified in their first year. For 15 cases, the resident had unresolved performance problems at the end of the program. Conclusion: There are 2 possible explanations for our findings: (1) resident problems similar to these are refractory to remediation; (2) treatments used historically are not well designed for the problems. Choosing among the 2 explanations will require developing remediation strategies targeted to specific patterns of performance problems.

Original languageEnglish (US)
Pages (from-to)651-658
Number of pages8
JournalSurgery
Volume145
Issue number6
DOIs
StatePublished - Jun 2009
Externally publishedYes

Fingerprint

Health Personnel
Communication
Delivery of Health Care
Problem Behavior
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

The nature of general surgery resident performance problems. / Williams, Reed G.; Roberts, Nicole K.; Schwind, Cathy J.; Dunnington, Gary.

In: Surgery, Vol. 145, No. 6, 06.2009, p. 651-658.

Research output: Contribution to journalArticle

Williams, Reed G. ; Roberts, Nicole K. ; Schwind, Cathy J. ; Dunnington, Gary. / The nature of general surgery resident performance problems. In: Surgery. 2009 ; Vol. 145, No. 6. pp. 651-658.
@article{a5d431c153a84cf2870ca7d978e8ac42,
title = "The nature of general surgery resident performance problems",
abstract = "Background: Residents with performance problems are challenging to program directors and complicate the work of other residents and health care providers. Having an effective, targeted remediation process to address these problems is dependent on being able to diagnose their nature. The purpose of this study was to identify residents who had serious, substantive, and recurring academic, clinical, and/or professional behavior problems, and to describe and classify their nature. Methods: Raters performed a retrospective record review of general surgery categorical residents in one program over 30 years. Residents with substantial problems were reviewed, described, and classified independently by 3 raters. Results: Seventeen residents had serious enough performance problems to be included. Four had only 1 class of problem (3 were professional behavior problems). Eight residents had 2 problems each (5 academic and clinical performance problems; 3 clinical performance and professional behavior problems). Five residents had 3 problems. The number of performance problem facets per case varied from 11 to 2 with an average of 5.9 facets. Relations with health care workers was identified most frequently, followed closely by insufficient knowledge. Poor communication was third. Performance problems of 14 residents (82{\%}) were identified in their first year. For 15 cases, the resident had unresolved performance problems at the end of the program. Conclusion: There are 2 possible explanations for our findings: (1) resident problems similar to these are refractory to remediation; (2) treatments used historically are not well designed for the problems. Choosing among the 2 explanations will require developing remediation strategies targeted to specific patterns of performance problems.",
author = "Williams, {Reed G.} and Roberts, {Nicole K.} and Schwind, {Cathy J.} and Gary Dunnington",
year = "2009",
month = "6",
doi = "10.1016/j.surg.2009.01.019",
language = "English (US)",
volume = "145",
pages = "651--658",
journal = "Surgery",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - The nature of general surgery resident performance problems

AU - Williams, Reed G.

AU - Roberts, Nicole K.

AU - Schwind, Cathy J.

AU - Dunnington, Gary

PY - 2009/6

Y1 - 2009/6

N2 - Background: Residents with performance problems are challenging to program directors and complicate the work of other residents and health care providers. Having an effective, targeted remediation process to address these problems is dependent on being able to diagnose their nature. The purpose of this study was to identify residents who had serious, substantive, and recurring academic, clinical, and/or professional behavior problems, and to describe and classify their nature. Methods: Raters performed a retrospective record review of general surgery categorical residents in one program over 30 years. Residents with substantial problems were reviewed, described, and classified independently by 3 raters. Results: Seventeen residents had serious enough performance problems to be included. Four had only 1 class of problem (3 were professional behavior problems). Eight residents had 2 problems each (5 academic and clinical performance problems; 3 clinical performance and professional behavior problems). Five residents had 3 problems. The number of performance problem facets per case varied from 11 to 2 with an average of 5.9 facets. Relations with health care workers was identified most frequently, followed closely by insufficient knowledge. Poor communication was third. Performance problems of 14 residents (82%) were identified in their first year. For 15 cases, the resident had unresolved performance problems at the end of the program. Conclusion: There are 2 possible explanations for our findings: (1) resident problems similar to these are refractory to remediation; (2) treatments used historically are not well designed for the problems. Choosing among the 2 explanations will require developing remediation strategies targeted to specific patterns of performance problems.

AB - Background: Residents with performance problems are challenging to program directors and complicate the work of other residents and health care providers. Having an effective, targeted remediation process to address these problems is dependent on being able to diagnose their nature. The purpose of this study was to identify residents who had serious, substantive, and recurring academic, clinical, and/or professional behavior problems, and to describe and classify their nature. Methods: Raters performed a retrospective record review of general surgery categorical residents in one program over 30 years. Residents with substantial problems were reviewed, described, and classified independently by 3 raters. Results: Seventeen residents had serious enough performance problems to be included. Four had only 1 class of problem (3 were professional behavior problems). Eight residents had 2 problems each (5 academic and clinical performance problems; 3 clinical performance and professional behavior problems). Five residents had 3 problems. The number of performance problem facets per case varied from 11 to 2 with an average of 5.9 facets. Relations with health care workers was identified most frequently, followed closely by insufficient knowledge. Poor communication was third. Performance problems of 14 residents (82%) were identified in their first year. For 15 cases, the resident had unresolved performance problems at the end of the program. Conclusion: There are 2 possible explanations for our findings: (1) resident problems similar to these are refractory to remediation; (2) treatments used historically are not well designed for the problems. Choosing among the 2 explanations will require developing remediation strategies targeted to specific patterns of performance problems.

UR - http://www.scopus.com/inward/record.url?scp=66049141212&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=66049141212&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2009.01.019

DO - 10.1016/j.surg.2009.01.019

M3 - Article

VL - 145

SP - 651

EP - 658

JO - Surgery

JF - Surgery

SN - 0039-6060

IS - 6

ER -