The faculty experience with the "troublesome" family practice resident.

BACKGROUND: Some family practice residents, by virtue of their behavior, generate discomfort, anger, and ambivalence in their supervising colleagues. These residents are labeled "troublesome." The purpose of this qualitative research was to identify and conceptualize characteristics of troublesome residents. METHODS: We retrospectively reviewed written evaluations of four residents who, out of a total of 111 residents in our program over five years, had been labeled "troublesome." Using the approach of constant comparisons, we identified a conceptual framework that described the troublesome residents. RESULTS: We were able to classify the comments in the residents' written evaluations into three categories. The first category was troublesome residents' discomforting behaviors. These included affronting, avoiding responsibility, and lack of initiative. The second category included ways in which the resident failed to meet faculty and program expectations, often manifest as lack of collaboration and commitment. The third category of comments involved the process of recognizing and dealing with the troublesome resident. This occurred in a three-stage process involving recognition, confrontation, and remediation. CONCLUSIONS: The classification of troublesome residents' performances into conceptual categories may be useful for helping faculty understand and deal with these learners.

Training for Rural Practice: What is Core Curriculum?

The question of postgraduate training for medical practice in rural communities has never been answered to everyone's satisfaction. Is there a core curriculum that would prepare a doctor to start up practice? The answer is no, but there is a better educational model that will foster physician attitudes, behaviour, and skills suitable for small-town practice. This article outlines some of the principles of a curriculum, the experiences required of a resident, and the setting and faculty that will make good small-town medicine happen. It addresses the changing illness and injury patterns of a modern rural community and the effect that these will have on the content of practice in the future.

Images of Illness: The shaking palsy.

The images we as physicians retain of our patients have a bearing on the evolution of our clinical behaviour and attributes. These images can enhance our diagnostic and therapeutic skills, increase our capacity to care for people with incurable diseases, and offer insights into our own emotional response. A recollection of five people with Parkinson's disease offers a college of images to give us further insights into the meaning of illness-for the patient and the physician.

The impact of pain on patient and physician.

A patient's pain has lost its status as an expression of personal suffering and is seen by both physician and patient as a strictly physical attribute. Because of this, their communication may become oblique and subversive, effectively destroying a therapeutic relationship. The patient's failure to recover causes the physician to suffer unease and begin assuming pain-reducing postures of anger, indifference and assertiveness. The physician, to avoid this scenario, must acknowledge the existential component of the patient's pain, the reality of his own discomfort, and be open enough to give personal suffering a place in the relationship.

Establishment of a community-based residency training program.

The Department of Family Practice at the University of British Columbia is now addressing the dearth of primary-care physicians in rural communities and, at the same time, attempting to improve the skills required for rural practice by sending its second-year residents directly to rural communities, where they learn experientially under the watchful eyes of well-established family physicians who are not only interested in teaching and learning, but also enjoy the companionship of a young family-practice resident.

Profile of your geriatric patient.

The family doctor cares for many geriatric patients. Many of these patients enter the family practice for the first time, having either recently moved to the area or to a nearby long-term care facility. Obtaining a meaningful patient profile is essential to the physicians' care, allowing future medical decisions to be made in the best interest of that person. Patients' beliefs motivate their functioning in a system. Any system has its own history, structure, and function.