Supporting Struggling Trainees with Performance Issues: Lessons from a UK Model

Approximately 6-9% of trainees will have performance issues of variable degrees with 3-5% of trainees struggling to complete their training and requiring additional targeted time or an extension of training. Some even leave the profession. The environment is complex, often chaotic and overstretched, and, now, made more difficult due to the impact of COVID-19 on medical training. Addressing learning and implementing new behaviours is a challenge and important, as there are still 'never events', and medical errors sadly can include wilful neglect and assault. Such traumatic experiences can be a huge drain of resources for faculty, who often feel underprepared to deal with such occurrences. Failure to address them can lead to bitterness and loss of the medical workforce, rarely suicide, huge remedial costs, and legal challenges to educational institutions and employers. The purpose of this paper is to gain an understanding of why trainees struggle and/or fail and to be able to analyse the causes of poor performance; to know how to pick up these issues early and raise them; and to ultimately deal effectively with performance problems to get a good outcome for the trainees, patients, and institutions.

How to play the game of medical education: Sociocultural analyses of educational difficulties among medical residents

This article was migrated. The article was marked as recommended. Medical residents in difficulty struggle to comply with educational requirements. They pose a liability to patient safety and they have problems to adapt to the professional role of a doctor. Consequently, being a resident in difficulty may cause identity crisis and have the potential to disrupt the resident's professional identity as a doctor. Only few studies explore the tipping point between becoming a resident in difficulty or not, and these studies rarely reflect the surrounding sociocultural aspects of the residents' difficulties such as organisational culture in the workplace. This article explores how medical residency training culture influence on residents' risk of ending in difficulty. Our study was based on six focus-group interviews with residents (n=28) and in-depth interviews with residents in difficulty (n=10). The interpretation of data employed sociologist Pierre Bourdieu's theoretical framework around dispositions. Across the data, we identified four themes: Conflicting games in the field of medical education, altruism, organisational hierarchy, and coping with stress. We found a (mis)match between legitimate rules in the field of medicine and the residents' dispositions to appreciate those rules. These results can inform clinical supervisors and consultants in their decisions for supporting residents in difficulty and increasing educational achievement among struggling residents.