LAUSR

The Challenge Struggling medical learners are not uncommon, comprising between 7% and 15% of trainees in >90% of all US internal medicine training programs across a spectrum of size, geographic location, and academic affiliation. Interactions with such learners present a unique set of challenges to clinical teaching. We provide this adapted definition of the struggling learner: a trainee who demonstrates a significant deficit requiring intervention, often secondary to specific affective, cognitive, organizational, or interpersonal difficulties, alone or in combination. The impact of these learners on the training environment and patient safety can be enormous. Learners with low levels of knowledge or with transgressions in professional behavior not only require a disproportionate amount of the teacher’s time and energy but also are more likely to encounter disciplinary action by state medical boards. Unfortunately, these learners rarely selfidentify. Instead, chief residents, program directors, and clinical teachers often detect these trainees through direct observation in the clinical setting or following critical incidents (eg, situations that create significant risk of harm to a patient).