title: Failure to fail: the perspectives of clinical supervisors.
abstract: BACKGROUND
  Clinical supervisors often do not fail students and residents even though they have judged their performance to be unsatisfactory. This study explored the factors identified by supervisors that affect their willingness to report poor clinical performance when completing In-Training Evaluation Reports (ITERs).
  
  
  METHODS
  Semistructured interviews with 21 clinical supervisors at the University of Ottawa were conducted and qualitatively analyzed.
  
  
  RESULTS
  Participants identified four major areas of the evaluation process that act as barriers to reporting a trainee who has performed poorly: (1) lack of documentation, (2) lack of knowledge of what to specifically document, (3) anticipating an appeal process and (4) lack of remediation options.
  
  
  CONCLUSIONS
  The study provides insight as to why supervisors fail to fail the poorly performing student and resident. It also offers suggestions of how to support supervisors, increasing the likelihood that they will provide a valid ITER when faced with an underachieving trainee.
authors.affiliation: 505 Smyth Road, Room 1105D, Ottawa, Ontario, Canada, K1H 8M2. ndudek@ottawahospital.on.ca
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Dudek
authors.forename: Meridith B
authors.initials: MB
authors.lastname: Marks
authors.forename: Glenn
authors.initials: G
authors.lastname: Regehr
mesh_terms: D002170:Canada; D002982:Clinical Clerkship; D002983:Clinical Competence; D004282:Documentation; D004521:Educational Measurement; D005260:Female; D013502:General Surgery / Q000193:education; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D007407:Interviews as Topic; D008297:Male; D011231:Preceptorship; D013337:Students, Medical