Is insufficient introspection a reason to terminate residency training? – Scrutinising introspection among residents who disputed dismissal

Abstract

Introduction

Insufficient introspection as part of the 4I’s model of medical professionalism (introspection, integrity, interaction, and involvement) is considered an important impediment in trainees. How insufficient introspection relates to decisions to terminate residency training remains unclear. Insights into this subject provide opportunities to improve the training of medical professionals.

Methods

We analysed the Dutch Conciliation Board decisions regarding residents dismissed from training between 2011 and 2020. We selected the decisions on residents deemed ‘insufficient’ regarding introspection as part of the CanMEDS professional domain and compared their characteristics with the decisions about residents without reported insufficiencies on introspection.

Results

Of the 120 decisions, 86 dismissed residents were unable to fulfil the requirements of the CanMEDS professional domain. Insufficient introspection was the most prominent insufficiency (73/86). These 73 decisions described more residents’ insufficiencies in CanMEDS competency domains compared to the rest of the decisions (3.8 vs. 2.7 p < 0.001), without significant differences regarding gender or years of training.

Conclusions

Insufficient introspection in residents correlates with competency shortcomings programme directors reported in dismissal disputes. The 4I’s model facilitates recognition and description of unprofessional behaviours, opening avenues for assessing and developing residents’ introspection, but further research is needed for effective implementation in medical education.

Keywords:

• Dismissal
• education law
• ethics/attitudes
• feedback
• postgraduate education
• professionalism

Ethical approval

The institutional review board (IRB) of Maastricht UMC + declared that the Medical Research Involving Human Subjects Act (WMO) does not apply to this study and official approval by the IRB is not required.

Author contributions

All authors were involved in the conception and design of this study. Data collection and coding were conducted by JG. SP independently coded a part of the data. Data analysis was conducted by JG and FG, and was further refined by all authors. JG wrote the first draft. The other authors then revised it critically for intellectual content, and all of them approved the article.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Funding

None.

Notes on contributors

Judith A. Godschalx-Dekker

Judith A. Godschalx-Dekker, MD, BA, LLB, LLM, is a psychiatrist/manager of the Department of Hospital Psychiatry and Medical Psychology at Flevoziekenhuis Almere, GGZ Centraal, The Netherlands.

Frank L. Gerritse

Frank L. Gerritse, MD, is a psychiatrist/manager of the Department of Hospital Psychiatry at Tergooi MC, Hilversum/Blaricum, The Netherlands.

Sebastiaan A. Pronk

Sebastiaan A. Pronk, MD, LLM, is a physician-researcher of the Academy for Postgraduate Medical Training, Maastricht University Medical Center, Maastricht, and physician sexual health at the municipal health services Limburg-North, The Netherlands.

Robbert J. Duvivier

Robbert J. Duvivier, MD, PhD, MBA, is senior researcher at the Center for Educational Development and Research in Health Sciences (CEDAR), Groningen University, and psychiatrist at Parnassia Psychiatric Institute, The Hague, The Netherlands, besides being a Conjoint Associate Professor in Medical Education at the University of Newcastle, Australia.

Walther N. K. A. van Mook

Walther N. K. A. van Mook, MD, PhD, is an internist/intensivist and vice chair of the Department of Intensive Care Medicine, Maastricht UMC + and Dean of the Academy for Postgraduate Training at Maastricht UMC + and professor of professional development at the School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.