Management of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary!

<h4>Aims of the study</h4>Residents in difficulty are a major cause for concern in medical education, with a prevalence of 7-15%. They are often detected late in their training and cannot make use of remediation plans. Nowadays, most training hospitals in Switzerland do not have a specif...

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Autores principales:	Cédric Lanier, Virginie Muller-Juge, Melissa Dominicé Dao, Jean-Michel Gaspoz, Noëlle Junod Perron, Marie-Claude Audétat
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/bb0421f7ff724afe8ce849ea71b987b1
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spelling	oai:doaj.org-article:bb0421f7ff724afe8ce849ea71b987b12021-12-02T20:09:06ZManagement of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary!1932-620310.1371/journal.pone.0254336https://doaj.org/article/bb0421f7ff724afe8ce849ea71b987b12021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254336https://doaj.org/toc/1932-6203<h4>Aims of the study</h4>Residents in difficulty are a major cause for concern in medical education, with a prevalence of 7-15%. They are often detected late in their training and cannot make use of remediation plans. Nowadays, most training hospitals in Switzerland do not have a specific program to identify and manage residents in difficulty. The aim of the study was to explore the challenges perceived by physicians regarding the process of identifying, diagnosing, and supporting residents in difficulty in a structured and programmatic way. We explored perceptions of physicians at different hierarchical levels (residents (R), Chief residents (CR), attending physicians (A), Chief Physician (CP)) in order to better understand these challenges.<h4>Methods</h4>We conducted an exploratory qualitative study between December 2015 and July 2016. We asked volunteers from the Primary Care Division of the Geneva University Hospitals to partake to three focus groups (with CR, A, R) and one interview with the division's CP. We transcribed, coded, and qualitatively analyzed the three focus groups and the interview, using a content thematic approach and Fishbein's conceptual framework.<h4>Results</h4>We identified similarities and differences in the challenges of the management of residents in difficulty on a programmatic way amongst physicians of different hierarchical levels. Our main findings: Supervisors (CR, A, CP) have good identification skills of residents in difficulty, but they did not put in place systematic remediation strategies.Supervisors (CR, A) were concerned about managing residents in difficulty. They were aware of the possible adverse effects on patient care, but "feared to harm" resident's career by documenting a poor institutional assessment.Residents "feared to share" their own difficulties with their supervisors. They thought that it would impact their career negatively.The four physician's hierarchical level reported environmental constraints (lack of funding, time constraint, lack of time and resources…).<h4>Conclusion</h4>Our results add two perspectives to specialized recommendations regarding the implementation of remediation programs for residents in difficulty. The first revolves around the need to identify and fully understand not only the beliefs but also the implicit norms and the feeling of self-efficacy that are shared by teachers and that are likely to motivate them to engage in the management of residents in difficulty. The second emphasizes the importance of analyzing these elements that constitute the context for a change and of identifying, in close contact with the heads of the institutions, which factors may favor or hinder it. This research action process has fostered awareness and discussions at different levels. Since then, various actions and processes have been put in place at the Faculty of Medicine in Geneva.Cédric LanierVirginie Muller-JugeMelissa Dominicé DaoJean-Michel GaspozNoëlle Junod PerronMarie-Claude AudétatPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254336 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Cédric Lanier Virginie Muller-Juge Melissa Dominicé Dao Jean-Michel Gaspoz Noëlle Junod Perron Marie-Claude Audétat Management of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary!
description	<h4>Aims of the study</h4>Residents in difficulty are a major cause for concern in medical education, with a prevalence of 7-15%. They are often detected late in their training and cannot make use of remediation plans. Nowadays, most training hospitals in Switzerland do not have a specific program to identify and manage residents in difficulty. The aim of the study was to explore the challenges perceived by physicians regarding the process of identifying, diagnosing, and supporting residents in difficulty in a structured and programmatic way. We explored perceptions of physicians at different hierarchical levels (residents (R), Chief residents (CR), attending physicians (A), Chief Physician (CP)) in order to better understand these challenges.<h4>Methods</h4>We conducted an exploratory qualitative study between December 2015 and July 2016. We asked volunteers from the Primary Care Division of the Geneva University Hospitals to partake to three focus groups (with CR, A, R) and one interview with the division's CP. We transcribed, coded, and qualitatively analyzed the three focus groups and the interview, using a content thematic approach and Fishbein's conceptual framework.<h4>Results</h4>We identified similarities and differences in the challenges of the management of residents in difficulty on a programmatic way amongst physicians of different hierarchical levels. Our main findings: Supervisors (CR, A, CP) have good identification skills of residents in difficulty, but they did not put in place systematic remediation strategies.Supervisors (CR, A) were concerned about managing residents in difficulty. They were aware of the possible adverse effects on patient care, but "feared to harm" resident's career by documenting a poor institutional assessment.Residents "feared to share" their own difficulties with their supervisors. They thought that it would impact their career negatively.The four physician's hierarchical level reported environmental constraints (lack of funding, time constraint, lack of time and resources…).<h4>Conclusion</h4>Our results add two perspectives to specialized recommendations regarding the implementation of remediation programs for residents in difficulty. The first revolves around the need to identify and fully understand not only the beliefs but also the implicit norms and the feeling of self-efficacy that are shared by teachers and that are likely to motivate them to engage in the management of residents in difficulty. The second emphasizes the importance of analyzing these elements that constitute the context for a change and of identifying, in close contact with the heads of the institutions, which factors may favor or hinder it. This research action process has fostered awareness and discussions at different levels. Since then, various actions and processes have been put in place at the Faculty of Medicine in Geneva.
format	article
author	Cédric Lanier Virginie Muller-Juge Melissa Dominicé Dao Jean-Michel Gaspoz Noëlle Junod Perron Marie-Claude Audétat
author_facet	Cédric Lanier Virginie Muller-Juge Melissa Dominicé Dao Jean-Michel Gaspoz Noëlle Junod Perron Marie-Claude Audétat
author_sort	Cédric Lanier
title	Management of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary!
title_short	Management of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary!
title_full	Management of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary!
title_fullStr	Management of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary!
title_full_unstemmed	Management of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary!
title_sort	management of residents in difficulty in a swiss general internal medicine outpatient clinic: change is necessary!
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/bb0421f7ff724afe8ce849ea71b987b1
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Management of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary!

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