Trainees with professional competency problems: Preparing trainers for difficult but necessary conversations

Trainees with professional competency problems, also called problems of professional competence (PPC), are frequently encountered by faculty and supervisors and often are challenging for trainers and educational/training systems. This article underscores the importance of trainers addressing graduate students and interns with PPC for whom regular summative and formative feedback has not been effective by engaging in the often difficult, but necessary, conversations as a first step in many remediation processes. These conversations are framed as an ethical responsibility and suggested as a core competency for trainers. Attention is paid to the myriad barriers that trainers often encounter in engaging in difficult conversations, including personal factors, training setting and systems issues, and the relationship between personal and contextual factors. Strategies are offered with regard to overcoming these barriers. In addition, recommended steps and tools for effective difficult conversations are provided. Implications of this work for trainers and training programs are noted.