Nature of the clinical difficulties of first-year family medicine residents under direct observation.

Objective: To determine and classify the difficulties of first-year family medicine residents observed during clinical interviews.

Design: Retrospective, descriptive study.

Setting: Family practice unit at a teaching hospital.

Participants: Forty-seven of the 56 first-year family medicine residents during their 2-month compulsory rotation in ambulatory family medicine, between July 1983 and December 1988, and 4 physicians who supervised the residents.

Main Outcome Measure: The residents' difficulties noted on the observation forms.

Main Results: A total of 1500 difficulties were observed during 194 interviews, an average of 7.7 (standard deviation 5.2) per interview. There were 167 different difficulties, which were classified into seven categories (introduction, initial contract, body of the interview, techniques and organization, interpersonal aspects, final contract and miscellaneous) and 20 subcategories. The 17 most frequently noted difficulties accounted for 40% of the total.

Conclusions: The results constitute a useful starting point for developing a classification of residents' difficulties during clinical interviews. We believe that the list of difficulties is applicable to residents at all levels and in other specialties, especially in ambulatory settings. The list can be used to develop learning materials for supervisors and residents.