© Springer International Publishing AG 2018 275
T.S. Köhler, B. Schwartz (eds.), Surgeons as Educators,
https://doi.org/10.1007/978-3-319-64728-9_17
Optimizing Success
for the Underperforming Resident
Karen Broquet and Jamie S. Padmore
Introduction
Residents who fail to meet standards across one or more competencies or demon-
strate problem behaviors that are significant enough to require intervention by pro-
gram leadership are conceptualized variously as “problem residents” [ 1 ], or
“residents in difficulty” [ 2 , 3 ]. Approximately 10% of residents across multiple spe-
cialties struggle with underperformance at some point [ 1 – 5 ]. Among surgical pro-
grams, the prevalence may be closer to 20–30% [ 6 – 9 ]. More than 90% of program
directors report having at least one problem resident in the past 1–3 years [ 1 , 4 , 5 ,
10 ]. Given enough time, it is likely that all program directors will encounter one or
more underperforming resident. Proactively addressing underperformance is highly
stressful for program directors and faculty. It can take a disproportionate amount of
time, be interpersonally uncomfortable, have an impact on faculty and resident
morale, and can sometimes lead to the painful decision that a particular resident
who may be far advanced in training does not possess the requisite skills to become
a competent safe practitioner in the specialty. In addition, underperforming resi-
dents often come to a program director’s attention via verbal reports with a paucity
of corresponding written documentation [ 11 , 12 ], leading to concerns of fairness,
due process, or legal ramifications for taking action. Helping a resident reach his or
her potential and succeed in training can be a gratifying experience. Conversely, not
addressing underperformance can lead to further problems as the trainee progresses
through training, including a threat to patient safety [ 13 ]. In this chapter, we will
K. Broquet, MD, MHPE (*)
Southern Illinois University School of Medicine, PO Box 19656, Springfield, IL 62794, USA
e-mail: [email protected]
J.S. Padmore, DM, MSc
Georgetown University School of Medicine and MedStar Health,
3900 Reservoir Road, NW, Med-Dent Building, NW-110, Washington, DC 20007, USA