Patient Complaints Against Doctors-in-Training Reveal Gaps in Communication and Professionalism

When patients leave a hospital dissatisfied, they often put their frustration in writing. Those letters, usually read as bureaucratic paperwork or legal risk, may in fact be one of the most underused educational resources in medicine. A new study from the Netherlands argues exactly that: complaints filed against residents — the doctors-in-training who deliver a large share of day-to-day hospital care — can be systematically analysed and fed back into postgraduate medical education, turning grievance into curriculum. The research, published in BMC Medical Education by a team from Maastricht University’s SHE School of Health Professions Education and Zuyderland Medical Centre, offers one of the first dedicated looks at what patients actually complain about when the person at the centre of the dispute is still in training.

The study was a descriptive qualitative investigation built on a retrospective review of complaint records. The researchers retrieved all patient complaints associated with residents that were registered at a large Dutch teaching hospital over a five-year window, from 2017 through 2021. In total, 602 complaints were linked to residents during that period. Rather than treating each complaint as an isolated incident, the team coded them against a well-established competency framework known as CanMEDS — the Canadian Medical Education Directives for Specialists — which describes the roles a competent physician must play: Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional. This framework is used across many training programmes worldwide, which makes it a natural lens for translating raw complaints into educational targets.

The headline finding is striking for how concentrated it is. The Communicator role accounted for 35 percent of all complaints against residents, with the Medical Expert role close behind at 34 percent and the Professional role contributing 21 percent. In other words, roughly two-thirds of everything patients complained about fell into just two buckets: how information was conveyed, and the clinical care itself. The remaining CanMEDS roles — Collaborator, Leader, Health Advocate and Scholar — made up the residual share. For educators, that distribution is actionable intelligence. It suggests that if training programmes want to reduce complaints, the highest-yield investments lie in communication skills and clinical decision-making, not in the more abstract organizational competencies.

Digging into the Communicator category, the authors highlight problems with correct and complete information as a recurring theme. Patients complained when they felt they had not been properly informed about their diagnosis, treatment plan, procedures or what to expect next. This is a subtle but important distinction from simply being rude or dismissive. A resident can be polite, empathetic and well-intentioned and still leave a patient confused about whether a medication should be taken with food, when a follow-up appointment will happen, or what a surgical complication means for recovery. The complaint data suggest that the completeness and accuracy of information transfer — not just the tone of the conversation — is where many resident-patient interactions break down.

The Medical Expert complaints, the second-largest cluster, relate to the core clinical competencies: diagnostic reasoning, treatment choices and technical performance. That residents attract complaints in this domain is not necessarily alarming — they are, by definition, still learning — but the volume is instructive. It signals that patients perceive gaps in clinical judgement or execution often enough to formalize grievances, and it gives programme directors a concrete signal about where supervision, simulation training and graduated autonomy might need reinforcement. The Professional category, at 21 percent, captures issues of conduct, responsibility and ethical behaviour, including attention to patients’ expectations, which the authors specifically flag as an area deserving more attention in postgraduate curricula.

What makes this study methodologically interesting is the framing of complaints as educational data rather than purely as a quality-assurance or medico-legal artifact. Healthcare complaints analysis tools, including the HCAT referenced in the paper, have been developed to code complaint narratives in a structured way, and pairing such coding with the CanMEDS roles creates a bridge between the patient’s experience and the competency framework that already structures residency training. In principle, a programme director could take an anonymized, aggregated complaint profile for their department and map it directly onto learning objectives, simulation scenarios and workplace-based assessments. A cluster of complaints about incomplete discharge instructions, for example, becomes a targeted communication exercise rather than an abstract exhortation to communicate better.

The context matters too. Residents occupy an awkward position in hospital hierarchies: they perform a substantial proportion of frontline clinical work, yet they are learners with variable experience and incomplete autonomy. Patients interact with them constantly — at the bedside, during rounds, in clinics and on the phone — which means residents are disproportionately the face of the hospital. The authors note that patient complaints against residents are growing, and that despite this trend, research specifically focused on complaints against residents has been lacking. Most complaint analyses pool all clinicians together, which obscures the training-specific signal. By isolating resident-linked complaints, this study gives educators a cleaner read on where the learning needs actually sit.

The implications run in both directions. For patients, a well-designed complaint-to-education pipeline promises a hospital system that learns: the next resident on the ward should be better prepared to explain a procedure fully, manage expectations honestly and follow through on commitments. For residents, the framing matters because complaints can be demoralizing and even career-damaging when handled punitively. Analysed constructively, they become formative feedback — uncomfortable, perhaps, but specific and grounded in real patient experience. The authors argue that good postgraduate medical education programmes can result in fewer complaints, which reframes complaint reduction as an outcome measure for educational quality rather than a disciplinary metric.

There are, of course, limits to what a single-centre retrospective analysis can establish. The data come from one large Dutch teaching hospital, and complaint patterns may differ across countries, cultures, complaint systems and specialties. Complaints also represent a skewed sample of patient experience: they capture the dissatisfied minority who took the trouble to file a formal grievance, not the silent majority, and coding narratives into competency categories inevitably involves interpretive judgement. The study was approved by the Medical Ethical Committee of Zuyderland Hospital, with informed consent waived for the retrospective record review, and it was conducted without external funding. Those are standard safeguards, but they do not erase the inherent constraints of qualitative complaint analysis.

Even so, the core message is likely to travel well beyond the Netherlands. Teaching hospitals everywhere sit on archives of complaint files that are consulted mainly by risk managers and lawyers. This study demonstrates a practical alternative: code them against a shared competency framework, identify the dominant failure modes — here, incomplete information, clinical expertise and professionalism — and route those findings into curriculum design, supervision practices and feedback for trainees. The Communicator role’s top ranking is a particularly portable lesson, because communication failures are consistently among the most common root causes of patient dissatisfaction and litigation worldwide. If the path from complaint to change becomes routine, the 602 grievances in this dataset will have done something no individual complaint could: taught an entire generation of doctors-in-training how to care for patients a little better.

Subject of Research: Analysis of patient complaints against medical residents to improve postgraduate medical education

Article Title: From complaint to change: analysing patient complaints against residents to enhance postgraduate medical education

Article References: van Montfoort, A., van der Baaren, L., van der Baan, N., Sosef, M., & Heyligers, I. (2026). From complaint to change: analysing patient complaints against residents to enhance postgraduate medical education. BMC Medical Education. https://doi.org/10.1186/s12909-026-10450-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10450-0

Keywords: patient complaints, residents, postgraduate medical education, CanMEDS, communication skills, medical professionalism, patient safety, teaching hospital, medical education, qualitative analysis, clinical training, healthcare quality