Failure to Fail

Journal Club Article: Gingerich, A., Sebok‐Syer, S. S., Larstone, R., Watling, C. J., & Lingard, L. (2020). Seeing but not believing: Insights into the intractability of failure to fail. Medical Education. Background Inadequate documentation of observed trainee incompetence persists. Documentation could be impeded if assessment language is misaligned with how supervisors conceptualise incompetence. There is a lack of adequate language to articulate judgements of incompetence, may complicate documentation. Documenting observed incompetence may be a singularly challenging task for assessors. Because frameworks tend to itemise competence as well as being vague about incompetence, assessment design may be improved by better understanding and describing of how supervisors experience being confronted with a potentially incompetent trainee. The need to identify the social rules regarding what can and cannot be said about incompetence when communicating with others. Methods

• constructivist grounded theory methodology around experiences supervising trainees who demonstrate incompetence
• Interviews
• 22 physicians

Results Bristled at the term ‘incompetence,’ so began to use ‘underperformance’ in its place. Underperformance was therefore unexpected and evoked disbelief in supervisors. Supervisors conceptualised underperformance as: an inability to engage with learning due to:

1. illness, a life event or learning disorders so that progression was stalled, or
2. an unwillingness to engage with learning due to lack of interest, insight or humility.

Summary Underperformance is seen as problematic progression due to insufficient engagement with learning that is unresponsive to intensified supervision. The phase of disbelief in trainers prevents confident documentation of performance and delays identification of underperformance.