title: Trainee underperformance: a guide to achieving resolution.
abstract: BACKGROUND
  Underperformance and the disharmony it can cause are not commonly faced by trainees. However, when it occurs, a process to recognize and manage the issues compassionately must be put in place.
  
  
  METHODS
  A literature review was undertaken to outline processes and themes in addressing and resolving these types of issues. A PubMed search using 'surgical underperformance' and 'remedial teaching' was used as a broad template to find papers that illustrated key concepts. One thousand four hundred and fifteen papers were identified. In papers where the titles were in line with the stated topic, 294 abstracts were reviewed. Key papers were used to develop themes. Additional cross-referenced papers were also included where relevant.
  
  
  RESULTS
  There can be a variety of reasons for trainee underperformance. The root cause is not always clear. Disharmony can result in a surgical unit during this time. The involved trainee as well as the members of the clinical unit may experience a variety of stressors. A systematic process of management can be used to evaluate the situation and bring some resolution to difficulties in working relationships.
  
  
  CONCLUSIONS
  Early constructive intervention improves outcomes. There should be a process to systematically and compassionately resolve underlying issues. This paper outlines the disharmony that can result from trainee underperformance and offers guidance for resolution to those involved.
authors: Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, University of New South Wales, Port Macquarie, New South Wales, Australia.
authors: Prem
authors: P
authors: Rashid
authors: Richard
authors: R
authors: Grills
authors: Melvyn
authors: M
authors: Kuan
authors: Deborah
authors: D
authors: Klein
mesh_terms: D001315:Australia; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate / Q000379:methods* / Q000592:standards; D000068156:Formative Feedback; D013502:General Surgery / Q000193:education*; D006801:Humans; D007398:Interpersonal Relations; D017008:Negotiating; D012073:Remedial Teaching; D013315:Stress, Psychological
keywords: conflict resolution; disharmony; management; trainee underperformance