Poor Performance Among Trainees in a Dutch Postgraduate GP Training Program.

Area of Science:

• Medical Education
• General Practice Training
• Healthcare Professional Development

Background:

• Poor trainee performance poses risks to patient safety and incurs economic costs.
• Early identification of underperforming trainees can facilitate timely remediation.
• Understanding the patterns of poor performance is crucial for improving training programs.

Purpose of the Study:

• To investigate the frequency, nature, and risk factors associated with poor performance in a Dutch postgraduate general practitioner (GP) training program.
• To identify specific competency domains where trainees struggle.
• To determine predictors of sustained poor performance throughout training.

Main Methods:

• A cohort of 215 trainees entering the GP program between 2005 and 2007 was analyzed.
• Multivariate logistic regression was used to assess associations between trainee characteristics, early assessments, training factors, and poor performance.
• Sub-analyses were conducted for each training year to identify temporal trends.

Main Results:

• 22.8% of trainees (49/215) demonstrated poor performance in at least one training year.
• In early years, issues were spread across medical expertise, communication, and professionalism; "professionalism" became the primary concern in the final year.
• Risk factors identified included older age, low initial scores in communication and knowledge, and previous year's poor performance (ORs 4.20-5.40).

Conclusions:

• Poor performance is common but often transient, with most trainees overcoming difficulties within a single year.
• This suggests trainees possess resilience and problem-solving capabilities.
• Age, early assessment deficiencies, and prior underperformance are significant risk factors for ongoing poor performance.