Dijkhuizen Kirsten, Bustraan Jacqueline, van den Bogaard Maartje E D, van Lith Jan M M, Driessen Erik, De Beaufort Arnout Jan
Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands.
Department of Engineering Education Research, University of Michigan, Ann Arbor, Michigan, USA.
BMJ Open. 2025 Jun 4;15(6):e088316. doi: 10.1136/bmjopen-2024-088316.
To gain insight into programme directors' (PDs') perceptions of trainee attrition from postgraduate medical education (PGME), focusing on interactions between stakeholders within the learning environment and roles of PDs in the process leading to attrition.
DESIGN, SETTING AND PARTICIPANTS: We performed a focus group study with 27 PDs from three Dutch teaching hospitals and analysed transcripts using template analysis.
PDs identified attrition as a multilevel problem, in which personal, workplace and system-bound factors play a role. PDs mentioned balancing professional and personal responsibilities, in particular parenthood and high ambitions, as important trainee-related factors. PDs adopt different, at times conflicting, roles when guiding trainees, for example, assessor and mentor, and they struggle to balance these roles. They displayed various emotions when discussing attrition, varying from disappointment to frustration and anger, yet could also frame attrition positively as new opportunity. PDs used numerous resources to support trainees in difficulty, in a reactive rather than in a pro-active manner. A generation difference between faculty and trainees regarding work-life balance was mentioned as impeding mutual understanding. On the system level, PDs observed how implicit beliefs and negative interactions between actors in the learning environment impede trainees' well-being.
PDs perceived trainee attrition as a multi-level problem that highlighted conflicting roles for the PD and evoked a wide range of emotions. The authors propose the following interventions: (1) address conflicting roles of PDs by reallocating specific tasks to other independent 'third parties', for example, professional coaching; (2) implement pro-active support for trainees unrelated to assessment; (3) create awareness of implicit assumptions of stakeholders and promote social belonging; (4) foster a supportive learning climate with clinical leaders as role models.
深入了解项目主任对研究生医学教育（PGME）中学员流失的看法，重点关注学习环境中利益相关者之间的互动以及项目主任在导致学员流失过程中的作用。
设计、背景和参与者：我们对来自三家荷兰教学医院的27名项目主任进行了焦点小组研究，并使用模板分析法分析了访谈记录。
项目主任将学员流失视为一个多层次问题，其中个人、工作场所和系统相关因素都发挥了作用。项目主任提到，平衡职业和个人责任，尤其是为人父母和雄心勃勃，是与学员相关的重要因素。项目主任在指导学员时扮演着不同的、有时甚至相互冲突的角色，例如评估者和导师，他们努力平衡这些角色。在讨论学员流失时，他们表现出各种情绪，从失望到沮丧和愤怒，但也可以将流失积极地视为新的机会。项目主任使用了大量资源以应对有困难的学员，且方式较为被动而非主动。教员和学员在工作与生活平衡方面的代际差异被认为阻碍了相互理解。在系统层面，项目主任观察到学习环境中行为者的隐性信念和负面互动如何妨碍学员的幸福感。
项目主任将学员流失视为一个多层次问题，这凸显了项目主任角色的冲突，并引发了广泛的情绪。作者提出以下干预措施：（1）通过将特定任务重新分配给其他独立的“第三方”（例如专业辅导）来解决项目主任角色冲突的问题；（2）对学员实施与评估无关的主动支持；（3）提高利益相关者对隐性假设的认识并促进社会归属感；（4）营造以临床领导者为榜样的支持性学习氛围。
