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.

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.