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Attitudes Towards Physicians Requiring Remediation

One-of-Us or Not-Like-Us?

Bourgeois-Law, Gisèle MD, MEd; Teunissen, Pim W. MD, PhD; Varpio, Lara PhD; Regehr, Glenn PhD

doi: 10.1097/ACM.0000000000002896
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Purpose: The data for this paper were collected as part of a larger project exploring how the medical profession conceptualizes the task of supporting physicians struggling with clinical competency issues. In this paper, the authors focus on a topic that has been absent in the literature thus far—how physicians requiring remediation are perceived by those responsible for organizing remediation and by their peers in general.

Method: Using a constructivist grounded theory approach, the authors conducted semi-structured interviews with 17 remediation stakeholders across Canada. Given that in Canada health is a provincial responsibility, the authors purposively sampled stakeholders from across provincial and language borders, and across the full range of organizations that could be considered as participating in the remediation of practicing physicians.

Results: Interviewees expressed mixed, sometimes contradictory, emotions towards and perceptions of physicians requiring remediation. They also noted that their colleagues, including physicians in training, were not always sympathetic to their struggling peers.

Conclusions: The medical profession’s attitude towards those who struggle with clinical competency—as individuals and as a whole—is ambivalent at best. This ambivalence grows out of psychological and cultural factors, and may be an undiscussed factor in the profession’s struggle to deal adequately with underperforming members. To contend with the challenge of remediating practicing physicians, the profession needs to address this ambivalence and its underlying causes.

G. Bourgeois-Law is clinical associate professor, Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, and a PhD candidate, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-4726-3663.

P.W. Teunissen is professor of medical education, School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands, and gynecologist, Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; ORCID: https://orcid.org/0000-0002-0930-0048.

L. Varpio is professor, Department of Medicine, and associate director of research, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0002-1412-4341.

G. Regehr is professor, Department of Surgery, and associate director for research, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia; Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002- 3144-331.

Funding/Support: Financial support for the preparation for this study was generously provided by a Medical Education Research Grant from the Royal College of Physicians and Surgeons of Canada

Other disclosures: None reported.

Disclaimer: The views expressed in this manuscript are those of the authors and not necessarily reflect those of the Department of Defense or other American federal agencies.

Ethical approval: This study was approved by the University of British Columbia Behavioral Research Ethics Board (protocol no. H16-00529).

Previous presentations: Some of these findings were reported at the 2017 meeting of the Association for Medical Education in Europe, Helsinki, Finland, and the 2018 Canadian Conference on Medical Education, Halifax, Nova Scotia, Canada.

Correspondence should be addressed to Gisèle Bourgeois-Law, Royal Jubilee Hospital, Coronation Annex, 1952 Bay Street, Victoria, British Columbia V8R 1J8, Canada; email: gisele.bourgeoislaw@ubc.ca

Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.

© 2019 by the Association of American Medical Colleges