TRAINING and EDUCATION
Diagnosing the Problem
Once you determine that someone has a
competency deficiency, you must consider
the etiology of the problem, which usually
falls into one of several buckets: knowledge,
skills, or attitude. The skill bucket is broad and
includes communication skills, organization,
efficiency, multi-tasking, and clinical
reasoning.
In my experience, “problematic” trainees
usually struggle with more than one issue.
Rarely is it just an insufficient fund of
knowledge or a lack of organization, for
example.
I carry this differential diagnosis of
competency deficiency around in my head,
and, when I meet with a trainee, I try to
figure out what underlying factors have
contributed to the problem. While the
competency committee may have helped to
identify a problem or validates the existence
of one suspected by the program director,
it is the program director’s responsibility
to meet with the fellow to look at the
potential barriers to success. A key aspect
to this meeting is determining whether the
problem is acute or chronic, and whether
the issue is personal or professional.”
Building a relationship with the fellow is
vital; I don’t always get the answers to these
questions in one meeting, and I certainly
don’t expect to sit down and have the trainee
open up to me if I haven’t created a trusting
environment. The fellow needs to believe
you are honestly trying to help him or her.
The competency deficiency could be
caused by an outside stressor: perhaps
the trainee has moved to a new location;
he or she may have just started a family
and has small children at home; he or she
could be having marital problems, or a
family member has a severe illness. At this
level in their training, fellows are working
extremely long hours and are gaining more
responsibilities; they are constantly under
the microscope. They are worried about
getting a job or a faculty position after
fellowship. Like anyone else, they can burn
out, and the stress can get overwhelming.
It may also be caused by a more
“chronic” issue. For example: Are there
learning barriers or mental health issues
(such as severe anxiety, performance
anxiety, ADHD, executive dysfunction
syndrome, or depression)? Are there
language barriers for a