Poor Performance Among Trainees in a Dutch Postgraduate GP Training Program.
OBJECTIVE
Poor performance among trainees is an important issue, for patient safety and economic reasons. While early identification might enhance remediation measures, we explored the frequency, nature, and risk factors of poor performance in a Dutch postgraduate general practitioner (GP) training program.


METHODS
All trainees who started the GP training between 2005 and 2007 were included. Multivariate logistic regression analysis was applied to examine associations between individual characteristics; early assessments of competencies and knowledge, training process characteristics (eg, illness, maternal leave), and the outcome poor performance; sub-analyses were performed for each year.


RESULTS
A total of 215 trainees started the 3-year GP program, and 49 (22.8%) exhibited poor performance (in one or more years). In the first and second years, problem areas among poor performers were equally distributed across the roles of "medical expert," "communicator," and "professional." In the third year, shortcomings in "professionalism" were the most common problem. Increasing age was a risk factor for poor performance as were insufficient scores in communication and knowledge. Poor performance in the previous year was a risk factor for poor performance in the second and third years; OR=4.20 (CI=1.31--13.47) and OR=5.40 (CI=1.58--18.47), respectively.


CONCLUSIONS
Poor performance is prevalent but primarily occurring within a single training year. This finding suggests that trainees are capable of solving trainee problems. Increasing age, insufficient assessment scores early in the training, and poor performance in a previous year constitute risk factors for poor performance.
University Medical Center Utrecht, Julius Center for Health Science and Primary Care, The Netherlands.
Margit I
MI
Vermeulen
Marijke M
MM
Kuyvenhoven
Esther
E
de Groot
Nicolaas Pa
NP
Zuithoff
Honore M
HM
Pieters
Yolanda
Y
van der Graaf
Roger Amj
RA
Damoiseaux
D000328:Adult; D000367:Age Factors; D002983:Clinical Competence; D003142:Communication; D004503:Education, Medical, Graduate; D004521:Educational Measurement / Q000592:standards*; D005260:Female; D058006:General Practice / Q000193:education* / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D009426:Netherlands; D012189:Retrospective Studies