Working with the "problem" resident: guidelines for definition and intervention.

Clinical teachers often work with residents whom they view as "difficult." For some, it is a knowledge deficit that first alerts them to a problem; for others, it is an attitudinal problem or distressing behavior. The goal of this article is to describe a framework for identifying residents' problems and to outline strategies for intervention. When teachers first suspect a problem, they should try to define the resident's troubling behavior, assess other contributing factors, and evaluate the potential impact of the problem. Following this initial process, teachers should try to confirm their suspicions by determining the resident's perception of the problem, relevant life history, and perceived strengths and weaknesses. They should also examine their own strengths and weaknesses and obtain other teachers' views of the perceived difficulty. In designing an intervention, teachers should carefully define the goal and time frame of the intervention, determine how the problem will be addressed, and decide how the intervention will be documented and evaluated. Although residents' difficulties are often seen as residing within the resident alone, teacher and systems factors must be considered, and the resident should be involved in every step of the process.