Dealing with disruptive residents

Residency Program Insider, April 11, 2006

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Dealing with disruptive residents

Program directors frequently deal with disruptive resident behavior that often results from stress, fatigue, and burnout. It's important to intervene early because residents who are frustrated with the system may take out these frustrations on others. Other stressors include:

Keep in mind that each new resident needs supervision and support to deal with his or her unique stressors. Fostering a culture of teamwork and support, including pairing new residents with senior resident mentors, can be critical to resident well-being.

The supervising resident and the program director are responsible for the safety of patients, as well as the professional development and appropriate discipline of residents. Program directors and chief residents should be trained in leading a resident group and in clearly defining the limits of behavior as part of orientation for all residents. Disruptive behavior includes:

  • Sexual harassment
  • Uncontrollable anger and frustration
  • Passive-aggressive behavior, such as not following rules
  • Writing inappropriate notes or e-mails
  • Angry outbursts at nurses

If a resident displays persistent disruptive behavior, he or she can create chaos on the ward. This behavior needs to be "nipped in the bud" by a wise and trained program director. Apply discipline with respect for all parties involved, document the process, and clearly explain to the resident that his or her behavior has been perceived as disruptive. Finally, explain to the resident that if he or she continues to act out, severe sanctions, including dismissal from the program, could result.

All the best,

Anderson Spickard, Jr., MD

Professor of Medicine
Medical Director, Center for Professional Health
Chair, Physician Wellness Committee
Vanderbilt Medical Center
Nashville, TN

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