title: The case of the entitled resident: a composite case study of a resident performance problem syndrome with interdisciplinary commentary.
abstract: BACKGROUND
  Residents with performance problems create substantial burden on programs and institutions. Understanding the nature and quality of performance problems can help in learning to address performance problems.
  
  
  OBJECTIVE
  We sought to illuminate the effects of resident performance problems and the potential solutions for those problems from the perspectives of people with various roles in health care.
  
  
  METHODS
  We created a composite portrait from several residents who demonstrated a cluster of common performance characteristics and whose chronic or serious maladaptive behavior and response to situations created problems for themselves, for their clinical colleagues, and for faculty of their residency program. The composite was derived from in-depth interviews of program directors and review of resident records. We solicited practitioners from multiple fields to respond to the portrait by answering a series of questions about severity, prognosis, and how and whether one could reliably remediate a person with these performance characteristics. We present their perspectives in a manner borrowed from the New England Journal of Medicine's "Case Records of the Massachusetts General Hospital."
  
  
  RESULTS
  We created a composite portrait of a resident whose behavior suggested he felt entitled to benefits his peers were not entitled to. Experts reflecting on his behavior varied in their opinion about the effect the resident would have on the health care system. They suggested approaches to remediation that required substantial time and effort from the faculty.
  
  
  CONCLUSIONS
  Programs must balance the needs of individual residents to adjust their behaviors with the needs of the health care system and other people within it.
authors.affiliation: Department of Medical Education, Southern Illinois University School of Medicine, P.O. Box 19681, Springfield, IL 62794-9681, USA. nroberts@siumed.edu
authors.forename: Nicole K
authors.initials: NK
authors.lastname: Roberts
authors.forename: Reed G
authors.initials: RG
authors.lastname: Williams
authors.forename: Mary
authors.initials: M
authors.lastname: Klingensmith
authors.forename: Maura
authors.initials: M
authors.lastname: Sullivan
authors.forename: Margaret
authors.initials: M
authors.lastname: Boehler
authors.forename: Gerald
authors.initials: G
authors.lastname: Hickson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kim
authors.forename: Debra L
authors.initials: DL
authors.lastname: Klamen
authors.forename: Theodore
authors.initials: T
authors.lastname: Leblang
authors.forename: Cathy
authors.initials: C
authors.lastname: Schwind
authors.forename: Kay
authors.initials: K
authors.lastname: Titchenal
authors.forename: Gary L
authors.initials: GL
authors.lastname: Dunnington
mesh_terms: D004503:Education, Medical, Graduate; D006801:Humans; D033183:Interdisciplinary Communication; D008505:Medical Staff, Hospital / Q000523:psychology*; D028743:Professional Misconduct / Q000523:psychology*; D036301:Qualitative Research; D012649:Self Concept