We read with keen interest the recently published article in Indian
Pediatrics about ‘problem resident’ .
The insights and ideas given in the article can be
enriched by further understanding following perspectives on human
behavior and its modification, in general:
1. The deviant behaviour that causes problems in
patient care is not just because of individual but also majorly due to
group culture, norms, resources and leadership, including behaviour of
other residents/faculty, and leadership style. Hence remedy will lie in
dealing with group behavior besides individual behavior. The entire
focus of the article  seems to be on rectifying the individual. Some
research needs to be done where one should examine whether certain
departments recurrently have more ‘problem students’ than other
departments. This research will prove or disprove our hypothesis that
group dynamics also creates ‘problem students’.
2. Behavior change and modification, both at
individual and group level, requires professional expertise, and cannot
be managed by doctors alone: hence, without professional help it may not
3. Public shaming process may happen when group
consensus technique mentioned for recognition of problem resident will
be used, besides violating confidentiality. It contradicts the later
mention of confidentiality requirement in the paper.
4. If real long-term solution is sought, behavioral
competencies like taking responsibility, and learning attitude,
emotional intelligence, self-discipline etc. should be formally
taught using experiential methodology during undergraduate and
postgraduate training. It should be incorporated by Education Council if
Medical Council of India wants to get doctors as per their expectations
(mentioned in paper at the beginning) in terms of human qualities.
Further, the teaching staff also needs training in building their skills
in emotional sensitivity and management of feelings besides leadership
5. Classification in terms of knowledge, skill and
attitude makes the issue too complex to be solved. Briefly, knowledge
and skill deficit do not cause problematic behaviour, whereas attitude
does. And attitude is too vast a subject involving beliefs, values,
evaluation, understanding and feelings. Feelings are the outcomes of
attitudes and hence easy to work with. It makes the correction path
simple and easy to implement. Enable these people to deal with
the uncomfortable feelings more functionally . This is also a long
drawn out process of learning through professional trainers/ therapists.
6. Skill deficits such as language, communication
etc. do not create ‘problem students’ whereas inability to take
constructive feedback may–if the student is highly defensive. Normal
defensiveness is there in all of us. Here again student is said to be a
problem, whereas inability to take constructive feedback can also be due
to judgemental communication by the feedback giver too.
1. Kaushik JS, Raghuraman K, Singh T, Gupta P.
Approach to handling a problem resident. Indian Pediatr. 2019;56:53-9.
2. Prakash P. Salient behavioural change processes
at self-level, In: Iyer L, Rane P, Waturuocha ZO, editors.
Learning Crucible: Collective Experiences From T Group Practice. New
Delhi: Indian Society for Applied Behaviour Sciences (ISABS); 2014. p.