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Indian Pediatr 2019;56:339-340

Facilitating Behavior Modification of ‘Problem Resident’: A Paradigm Shift in Approach

Arti Maria1 and Pradeep Prakash2

1Department of Neonatology, PGIMER, Dr RML Hospital, and 2Independent Consultant;
New Delhi, India.
Email: artimaria@gmail.com



We read with keen interest the recently published article in Indian Pediatrics about ‘problem resident’ [1].

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 [1] 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 succeed.

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 skills.

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 [2]. 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. 113-23.


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