Residents in trouble: An in-depth assessment of the 25-year experience of a single family medicine residency

Background and Objectives: Graduate medical education program directors struggle with resident trainees who develop problems in academic and personal spheres leading to probation, resignation, or termination of training. These "residents in trouble" generate a disproportionate amount of work and can demoralize faculty and residents. Only two prior studies have identified the prevalence of residents in trouble. In both studies, the prevalence was based on nonvalidated program director self-report. In contrast, our study uses a review of primary data sources to describe the prevalence, types of problems, remediation methods, and outcomes for residents in trouble over the 25-year experience of a residency program. Methods: Five primary data sources were reviewed for every trainee who was enrolled from 1978-2003 at the David Grant Medical Center Family Medicine Residency, looking for any of eight types of occurrences previously identified in the literature as marking a resident in trouble. Results: Over this 25-year period, 230 residents entered training and 209 graduated. The prevalence of residents in trouble was 9.1%. The types of problems encountered included divorce, psychiatric illness, substance abuse, attitudinal problems, interpersonal conflict, excessive patient complaints, and insufficient knowledge. A variety of remediation approaches were used, and 90% of the residents in trouble graduated. Conclusions: The 9.1% provides a point of comparison for program directors to know if their residency has a disproportionate rate of problems requiring organizational reform or if they are dealing with the normative experience of a training program. Our program's experience supports five suggestions for the management of residents in trouble.