1. We agree that deviant behaviour of an individual can result from
lacunae in the group dynamics, deficits in the system, or lack of team
leadership. The same has been acknowledged in the draft and has been
discussed under the section on problems pertaining to teachers and
problems pertaining to system. These factors pertaining to resident,
teacher or system are considered as ‘predisposing factors’ and not
‘causative factors. Hence, the problem that we encounter could have been
predisposed by one or more than one factor. Nowhere in the draft, do we
intend to blame an individual for the ‘problem’ in the ‘problem
2. For the lack of trained experts, it may not be
practical to seek professional help for every small issue at hospital.
There is a need to develop awareness among the teachers who need to be
sensitized on how to tackle the issues at their level. Professional help
would definitely be required when it cannot be handled by the teachers
or the program director. The same has also been acknowledged in the
3. Group consensus among faculty members in a closed
room discussion of faculty members does not lead to public shaming. It
clearly intends to clarify if it is an individual faculty’s opinion or
is it that the same issue has been encountered by other faculty members
as well. This does not breach confidentiality of the student. This step
often takes care of unnecessary harassment of the student based on
single person’s opinion. Thus, it is essential to reach a group
consensus before remedial actions can be planned.
4. Medical Council of India has commenced Attitude
and Communication (ATCOM) module in this regard to train undergraduates.
This should probably address this concern.
5. It would be good to look at the article from the
perspective of medical teacher rather than a behavioral psychologist.
Article did not intend in-depth discussions of psychology behind
attitudes, beliefs, values that are well beyond the expertise of the
authors or the scope of the article. We believe that a simple
classification like deficits in knowledge, skill and attitude does not
add complexity when looked from the perspective of medical teachers.
6. I would bring back the attention of the reader to
‘predisposing factor’ and not causative factor. No where do we mention
that deficit in communication alone or lack of ability to take
constructive criticism leads to problems in a problem resident. We
believe that lack of these essential skills like effective communication
often adds fuel to the fire.