Intended for healthcare professionals

Practice Teaching Rounds

The “problem” junior: whose problem is it?

BMJ 2008; 336 doi: (Published 17 January 2008) Cite this as: BMJ 2008;336:150
  1. Yvonne Steinert, director
  1. 1Centre for Medical Education, Faculty of Medicine, Lady Meredith House, McGill University, 1110 Pine Avenue West, Montreal, QC, Canada H3A 1A3
  1. yvonne.steinert{at}

    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

    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 James and Dr Roberts (see box 1) and perceived them as challenging or difficult; others may not. This article describes an approach to identifying, diagnosing, and working with problem learners1 2 that has been used successfully in our setting.

    Box 1 Case scenario

    Dr James
    • Ward staff have complained to you about Dr James, a junior house officer who has been working with you for three months. Apparently he is slow to answer his pager, ignores requests to complete discharge summaries, and can be abrupt with staff and patients. He often makes dismissive comments about patients and other team members. However, no one doubts his medical competence

    Dr Roberts
    • Dr Roberts is completing her rotation in internal medicine. She is well liked by everyone but seems indecisive and disorganised. …

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