BMJ  2008;336:150-153 (19 January), doi:10.1136/bmj.39308.610081.AD

Practice

Teaching Rounds

The "problem" junior: whose problem is it?

¹ Centre for Medical Education, Faculty of Medicine, Lady Meredith House, McGill University, 1110 Pine Avenue West, Montreal, QC, Canada H3A 1A3

When working with "problem" learners, clinical teachers often feel at a loss as to how to tackle the difficulties. This article offers guidance on how to do this

The first 150 words of the full text of this article appear below.

Summary points A "problem" junior may be a learner who does not meet expectations because of problems in one of three areas: knowledge, attitudes, or skills Teachers must identify whether the problem lies with the teacher, the learner, and/or the system Careful data gathering with the learner is essential before any intervention Teachers must identify learners’ strengths as well as areas for improvement Interventions may include increased observation and feedback, additional time with a faculty adviser, weekly study sessions, core content review, videotaping of clinical encounters, or counselling Teachers must work collaboratively with the junior doctor to ensure "due process" and guarantee fairness, confidentiality, and informed consent

Clinical teachers often work with junior doctors whom they find challenging or "difficult." However, we all view learners’ problems differently, and whether we label a junior doctor as a "problem" doctor depends on many factors. Some of us may have encountered junior doctors like Dr . . . [Full text of this article]

Box 1 Case scenario

Dr James
Dr Roberts

What do we know about problem learners?

How can we best work with problem learners?

Define the "problem"
Teachers’ problems
Learners’ problems
Systems problems
Is change necessary?
Confirm the "diagnosis"
Box 2 Case scenario: defining the problem
Dr James
Dr Roberts
Design and implement an intervention
Box 3 Working with problem juniors: options for intervention
Box 4 Case scenario: designing interventions
Dr James
Dr Roberts
Assure "due process"

What other challenges do we face with problem learners?

How can we prevent learners’ problems?

Conclusion

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