Difficulties in Residency: An Examination of Clinical Rotations and Competencies Where Family Medicine Residents Most Often Struggle

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BACKGROUND AND OBJECTIVES: Remediation in residency is expensive; however, most research has focused on general approaches to remediation, with minimal investigation into whether there are patterns to the competencies or rotations that are most difficult for residents. Acquiring this information may improve future physician training and potentially reduce the frequency of resource-intensive remediation. We aimed to determine the competencies and rotations most challenging for family medicine residents, as defined by the number of assessments with flags (one or more competencies indicated as less than satisfactory). METHODS: A secondary data analysis of archived resident files from a large Canadian family medicine residency program was conducted. Residents from six cohorts were reviewed (N=393) and flags on the in-training evaluation reports (ITERs) and summative periodic progress reports were recorded and summarized with descriptive statistics. RESULTS: One hundred forty-one residents (36%) received at least one flag during training. Rotations where learners received the most flags were: internal medicine (average 1.52±4.82 flags), urban family medicine (average 1.48±4.18), and obstetrics (average 1.07±3.80). For residents having at least one flag, competencies causing most difficulty included: professionalism (21.4%), clinical decision making (17.8%), and teamwork and communication (15.5%). CONCLUSIONS: The file review identified coronary care unit, internal medicine, obstetrics, and general surgery as those rotations (adjusted for length) where family medicine residents most often struggled. Furthermore, deficient clinical knowledge was not one of the main reasons that residents are flagged. These findings may inform programs about where to target resident supports and resources.

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