Constructive ways to prevent, identify, and remediate deficiencies of “challenging trainees” in experiential education

The practice of pharmacy is highly influenced by the training pharmacy clinicians receive through experiential education (EE) programs, for it is within this “total practice immersion” that their skills are shaped, honed, and refined.1 However, not all rotation experiences are positive for both preceptor and trainee. Due to trainees’ diverse backgrounds, personalities, and expectations, as well as diversity in practice environments and other possible factors, preceptors may encounter trainees with poor academic or clinical performance, a lack of practical experience or professional maturity, or life circumstances that result in less than desirable educational outcomes. When faced with a challenging trainee situation, preceptors are expected to navigate all types of challenges deftly and with confidence. A breadth of pharmacy literature regarding best practices in precepting is available, but there is very little literature addressing how to handle challenging situations with trainees.2–5 The terminology used to define and characterize suboptimally performing trainees in pharmacy and medicine is varied and often applied cautiously so as not to label or stigmatize. The terms “trainee in crisis,” “trainee in difficulty,” “challenging trainee,” “dyscompetent trainee,” “disruptive student,” “marginal student,” and “problem learner” have been used in published literature and preceptor training programs to characterize underperforming trainees.6–10 The American Board of Internal Medicine (ABIM) defines a “problem resident” as a “learner who demonstrates problem behaviors significant enough to require intervention by program leadership.”7 The American Medical Association defines behavioral problems as “personal conduct, whether verbal or physical, that negatively affects or potentially affects patient care, including conduct that interferes with one’s ability to work with members of a health care team.”11 Equivalent definitions are not found in the pharmacy literature. For the remainder of this article, “challenging trainee” denotes a pharmacy student or pharmacy resident who is performing below preceptor expectations with regard to knowledge, attitude, or skill set.