title: [Disagreements between GP trainees and their seniors. Management and impacts on the hidden curriculum. Qualitative study of 37 situations in Paris].
abstract: Disagreements and conflicts have a negative impact on the satisfaction and the performances of working team members. Young doctors in training are part of the health care team. The management of the disagreements with which they are confronted is a part of their professionalization process.
  
  
  OBJECTIVE
  To clarify and analyze the disagreements between GP trainees and their seniors in patients care and their consequences in doctor curriculum.
  
  
  METHODS
  Qualitative descriptive study. Five focus groups including a total of 25 Parisian trainees were performed to explore situations of disagreements with their seniors about patients care. Phenomenical analysis was performed by two researchers.
  
  
  RESULTS
  Thirty-seven situations were reported. A number of potential sources of conflicts were highlighted. Factors that can transform a disagreement into an insoluble conflict were identified. The consequences of these disagreements on the quality of care and their impact on the empowerment of trainees were analysed. Number of disagreements related patients facing end of life. Specificities of emergency contexts and ambulatory practice were underlined. The role of the hierarchical link in the genesis and the development of the conflicts was confirmed. The personality of the trainee, his conception of responsibility, the exchange of knowledge, the "commercial" aspects of doctors practice can be at the origin of conflicts.
  
  
  CONCLUSIONS
  The disagreements can play a positive role in trainees empowerment. A training in the management of anticipated or known conflicts can usefully clarify and optimize the hidden curriculum of the medical students towards professionalism.
authors.affiliation: Université Paris Diderot, département de médecine générale, 16, rue Henri-Huchard, 75018 Paris, France. Electronic address: egalam@hotmail.com.
authors.forename: Éric
authors.initials: É
authors.lastname: Galam
authors.affiliation: Université Paris Diderot, département de médecine générale, 16, rue Henri-Huchard, 75018 Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Multon
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003220:Conflict, Psychological; D034462:Dissent and Disputes; D004632:Emergency Medical Services; D004644:Emotions; D005260:Female; D017144:Focus Groups; D058006:General Practice / Q000193:education* / Q000379:methods; D058005:General Practitioners / Q000523:psychology*; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D017008:Negotiating; D010297:Paris; D005791:Patient Care; D017009:Professional Autonomy; D036301:Qualitative Research; D013727:Terminal Care