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Introduction: Problem residents are common in graduate medical education, yet little is known about their characteristics, deficits, and the consequences for emergency medicine (EM) residencies. The American Board of Internal Medicine (ABIM) defines a problem resident as “a trainee who demonstrates a significant enough problem that requires intervention by someone of authority, usually the program director [PD] or chief resident.” Although this is a comprehensive definition, it lacks specificity. Our study seeks to add granularity and nuance to the definition of “problem resident,” which can be used to guide the recruitment, selection, and training of residents.  Methods: We conducted semi-structured interviews with a convenience sample of EM PDs between 2011 and 2012. We performed qualitative analysis of the resulting transcripts with our thematic analysis based on the principles of grounded theory. We reached thematic sufficiency after 17 interviews. Interviews were coded as a team through consensus.  Results: The analysis identified diversity in the type, severity, fixability, and attribution of problems among problem residents. PDs applied a variety of thresholds to define a problem resident with many directly rejecting the ABIM definition. There was consistency in defining academic problems and some medical problems as “fixable.” In contrast, personality problems were consistently defined as “non-fixable.” Despite the diversity of the definition, there was consensus that residents who caused “turbulence” were problem residents. Conclusion: The ABIM definition of the problem resident captures trainees who many PDs do not consider problem residents. We propose that an alternative definition of the problem resident would be “a resident with a negative sphere of influence beyond their personal struggle.” This combination acknowledges the identified themes of turbulence and the diversity of threshold. Further, the combination of PDs’ unwillingness to terminate trainees and the presence of non-fixable problems implies the need for a “front-door” solution that emphasizes personality issues at the potential expense of academic potential. This “front-door” solution depends on the commitment of all stakeholders including medical schools, the Association of American Medical Colleges, and PDs.

Introduction: There is significant symptom overlap between fetal alcohol spectrum disorder (FASD), which results from prenatal alcohol exposure (PAE), and autism spectrum disorder (ASD). There is also limited research regarding the comorbidity of these disorders. Method: Thirty-nine individuals with ASD and PAE (ASD+PAE) aged 3 to 30 years were matched for age, sex, and IQ to 78 individuals with PAE-only and compared on demographics, comorbid conditions, and 9 domains of neurodevelopmental function. Results: The ASD+PAE group were significantly more likely to have deficits in motor and daily living skills. They also had a greater number of impaired neurodevelopmental domains overall. They were diagnosed with ADHD more often and reported more sensory sensitivities, self-regulation difficulties, and social skills deficits. Conclusions: Overall, the ASD+PAE group had a more complex and severe presentation of symptoms. The relationship between ASD, FASD, and PAE as well as the value of providing an ASD diagnosis in the context of PAE are discussed.

This study presents a conceptual understanding of how mentorship is experienced by the participants of a mentorship program for university students with Autism Spectrum Disorder. We interviewed the participants of the Autism Mentorship Initiative at Simon Fraser University. A grounded theory approach was used to systematically organize data from interviews and documents to reveal themes that were salient to the mentees (students with autism; n = 9) and mentors (neurotypical students; n = 9). The following five main themes were identified and interrelated under the core theme of A Mentee-centered Approach: (1) The Natural Progression of the Relationship, (2) The Supportive Mentor, (3) The Meeting Process, (4) Identifying and Implementing Goals, and (5) Learning Together. An in-depth analysis of a mentorship process is described.

This study sought to determine the academic and professional outcomes of medical school graduates who failed the United States Licensing Examination Step 1 on the first attempt. This retrospective cohort study was based on pooled data from 2,003 graduates of six Midwestern medical schools in the classes of 1997-2002. Demographic, academic, and career characteristics of graduates who failed Step 1 on the first attempt were compared to graduates who initially passed. Fifty medical school graduates (2.5%) initially failed Step 1. Compared to graduates who initially passed Step 1, a higher proportion of graduates who initially failed Step 1 became primary care physicians (26/49 [53%] vs. 766/1,870 [40.9%]), were more likely at graduation to report intent to practice in underserved areas (28/50 [56%] vs. 419/1,939 [21.6%]), and more likely to take 5 or more years to graduate (11/50 [22.0%] vs. 79/1,953 [4.0%]). The relative risk of first attempt Step 1 failure for medical school graduates was 13.4 for African Americans, 7.4 for Latinos, 3.6 for matriculants greater than 22 years of age, 3.2 for women, and 2.3 for first generation college graduates. The relative risk of not being specialty board certified for those graduates who initially failed Step 1 was 2.2. Our observations regarding characteristics of graduates in our study cohort who initially failed Step 1 can inform efforts by medical schools to identify and assist students who are at particular risk of failing Step 1.

The primary goal of education is to provide meaningful instruction to all students while fostering generalization throughout the curriculum and beyond. As such, educators continuously seek out instructional methods and techniques to appropriately meet individual student needs while choosing "what" and "how" to teach. The current work provides an overview of mindfulness as it relates to other popular methods of instruction and learning. In doing so, the coexistence of mindful principles and effective teaching practices that underlie student learning is explored.

Attention deficit/hyperactivity disorder (ADHD) is a behavioral disorder characterized by inattention, impulsivity, and hyperactivity. The presence of ADHD is associated with behavioral and academic difficulties within a classroom setting. With a prevalence rate of 3% to 5%, teachers will undoubtedly come in contact with a student with ADHD at one point or another. Therefore, it would behoove teachers to be aware of effective interventions that help alleviate some of the difficulties students with ADHD may present. Classwide interventions (i.e., interventions used with the entire classroom) that target students with ADHD may be a plausible alternative to the highly individualized interventions typically recommended for students with ADHD. This article summarizes some effective classwide interventions for ADHD to allow teachers to select from a menu of options. For each intervention discussed, the critical features of the intervention are described, its associated behavioral and academics benefits summarized, and the authors' interpretation of the advantages and disadvantages of its use are presented. (Contains 2 tables.)