[Disagreements between GP trainees and their seniors. Management and impacts on the hidden curriculum. Qualitative study of 37 situations in Paris]

Abstract

Interest of the work: Disagreements and conflicts have a negative impact on the satisfaction and the performances of working team members. Young doctors in training are part of the health care team. The management of the disagreements with which they are confronted is a part of their professionalization process.

Objective: To clarify and analyze the disagreements between GP trainees and their seniors in patients care and their consequences in doctor curriculum.

Methods: Qualitative descriptive study. Five focus groups including a total of 25 Parisian trainees were performed to explore situations of disagreements with their seniors about patients care. Phenomenical analysis was performed by two researchers.

Results: Thirty-seven situations were reported. A number of potential sources of conflicts were highlighted. Factors that can transform a disagreement into an insoluble conflict were identified. The consequences of these disagreements on the quality of care and their impact on the empowerment of trainees were analysed. Number of disagreements related patients facing end of life. Specificities of emergency contexts and ambulatory practice were underlined. The role of the hierarchical link in the genesis and the development of the conflicts was confirmed. The personality of the trainee, his conception of responsibility, the exchange of knowledge, the "commercial" aspects of doctors practice can be at the origin of conflicts.

Perspectives: The disagreements can play a positive role in trainees empowerment. A training in the management of anticipated or known conflicts can usefully clarify and optimize the hidden curriculum of the medical students towards professionalism.