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

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          Abstract

          Aims of the study

          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.

          Methods

          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.

          Results

          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…).

          Conclusion

          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.

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          Most cited references 48

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          Participatory action research.

          This glossary aims to clarify some of the key concepts associated with participatory action research.
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            Giving feedback in clinical settings

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              Strategic development and SWOT analysis at the University of Warwick

               Robert Dyson (2004)
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                20 July 2021
                2021
                : 16
                : 7
                Affiliations
                [1 ] Family Medicine Unit (UIGP), University of Geneva, Geneva, Switzerland
                [2 ] Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
                [3 ] Hirslanden Clinique des Grangettes, Chênes-Bougeries, Switzerland
                [4 ] Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
                Imam Abdulrahman Bin Faisal University, SAUDI ARABIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Article
                PONE-D-20-15571
                10.1371/journal.pone.0254336
                8291751
                34283854
                © 2021 Lanier et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 2, Tables: 1, Pages: 16
                Product
                Funding
                Funded by: university of geneva
                Award Recipient :
                The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This project was supported by institutional Funding Elie SAFRA from the Faculty of Medicine, University of Geneva.
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                There are ethical restrictions on sharing the data publicly, as it contains sensitive information from doctors and could facilitate participant identification. Certain topics are sensitive on an institutional level and can only be accessed upon request through the University of Geneva's Yareta repository ( https://doi.org/10.26037/yareta:d5unipemxjahvno53oyla4flqu). Alternatively, data access requests may be sent to the ethics committee IRB of the University of Geneva - UNIGE and the IRB of the university hospitals - HUG - CCER ( Sophie.Desjacques@ 123456unige.ch ).

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