{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:53:26Z","timestamp":1792151606622,"version":"4.4.0"},"reference-count":33,"publisher":"Elsevier BV","issue":"11","license":[{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Education"],"published-print":{"date-parts":[[2026,11]]},"DOI":"10.1016\/j.jsurg.2026.104196","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:08:40Z","timestamp":1790838520000},"page":"104196","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Viewing the Underperforming Trainee Using a System Dynamics Lens: Understanding the Impact of Interprofessional Interactions in a Healthcare System"],"prefix":"10.1016","volume":"83","author":[{"given":"Lori R.","family":"Berkowitz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8504-8967","authenticated-orcid":false,"given":"Rebecca L.","family":"Dunkailo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Healy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Bradley","family":"Morrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"1","key":"10.1016\/j.jsurg.2026.104196_bib0001","first-page":"18","article-title":"Dealing with trainees in difficulty","volume":"4","author":"Mahmood","year":"2012","journal-title":"Facts Views Vis Obgyn"},{"issue":"5","key":"10.1016\/j.jsurg.2026.104196_bib0002","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1080\/14739879.2013.11494201","article-title":"GP trainers\u2019 experience of managing a trainee in difficulty: a qualitative study","volume":"24","author":"McLaren","year":"2013","journal-title":"Educ Prim Care"},{"issue":"10 Suppl","key":"10.1016\/j.jsurg.2026.104196_bib0003","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.1097\/ACM.0b013e31822a603d","article-title":"Using self-regulated learning theory to understand the beliefs, emotions, and behaviors of struggling medical students","volume":"86","author":"Artino","year":"2011","journal-title":"Acad Med"},{"issue":"10","key":"10.1016\/j.jsurg.2026.104196_bib0004","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-025943","article-title":"Remediating doctors\u2019 performance to restore patient safety: a realist review protocol","volume":"8","author":"Price","year":"2018","journal-title":"BMJ Open"},{"issue":"3","key":"10.1016\/j.jsurg.2026.104196_bib0005","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/0749-5978(89)90041-1","article-title":"Misperceptions of feedback in dynamic decision making","volume":"43","author":"Sterman","year":"1989","journal-title":"Org Behav Hum Decis Process"},{"issue":"4","key":"10.1016\/j.jsurg.2026.104196_bib0006","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1002\/sdr.198","article-title":"Bathtub dynamics: initial results of a systems thinking inventory","volume":"16","author":"Sweeney","year":"2000","journal-title":"Syst Dyn Rev"},{"issue":"3","key":"10.1016\/j.jsurg.2026.104196_bib0007","doi-asserted-by":"crossref","first-page":"505","DOI":"10.2105\/AJPH.2005.066043","article-title":"Learning from evidence in a complex world","volume":"96","author":"Sterman","year":"2006","journal-title":"Am J Public Health"},{"issue":"2","key":"10.1016\/j.jsurg.2026.104196_bib0008","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1002\/sdr.4260090203","article-title":"Systems thinking: critical thinking skills for the 1990s and beyond","volume":"9","author":"Richmond","year":"1993","journal-title":"Syst Dyn Rev"},{"issue":"suppl 4","key":"10.1016\/j.jsurg.2026.104196_bib0009","doi-asserted-by":"crossref","first-page":"iv1","DOI":"10.1093\/heapol\/czs084","article-title":"Systems thinking for strengthening health systems in LMICs: need for a paradigm shift","volume":"27","author":"Adam","year":"2012","journal-title":"Health Policy Plan"},{"key":"10.1016\/j.jsurg.2026.104196_bib0010","series-title":"Business Dynamics: Systems Thinking and Modeling for a Complex World","author":"Sterman","year":"2000"},{"issue":"S1","key":"10.1016\/j.jsurg.2026.104196_bib0011","doi-asserted-by":"crossref","first-page":"S55","DOI":"10.1089\/apc.2014.0276","article-title":"Simulating patterns of patient engagement, treatment adherence, and viral suppression: a system dynamics approach to evaluating HIV care management","volume":"29","author":"Lounsbury","year":"2015","journal-title":"AIDS Patient Care STDS"},{"issue":"1","key":"10.1016\/j.jsurg.2026.104196_bib0012","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1037\/met0000484","article-title":"Refining the causal loop diagram: a tutorial for maximizing the contribution of domain expertise in computational system dynamics modeling","volume":"29","author":"Crielaard","year":"2024","journal-title":"Psychol Methods"},{"issue":"5 Suppl","key":"10.1016\/j.jsurg.2026.104196_bib0013","doi-asserted-by":"crossref","first-page":"S34","DOI":"10.1016\/j.amjmed.2008.02.003","article-title":"Sidestepping superstitious learning, ambiguity, and other roadblocks: a feedback model of diagnostic problem solving","volume":"121","author":"Rudolph","year":"2008","journal-title":"Am J Med"},{"issue":"3","key":"10.1016\/j.jsurg.2026.104196_bib0014","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1017\/S0033291715002044","article-title":"Depression as a systemic syndrome: mapping the feedback loops of major depressive disorder","volume":"46","author":"Wittenborn","year":"2016","journal-title":"Psychol Med"},{"issue":"2","key":"10.1016\/j.jsurg.2026.104196_bib0015","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1080\/10401334.2011.561758","article-title":"Systems-based practice in graduate medical education: systems thinking as the missing foundational construct","volume":"23","author":"Colbert","year":"2011","journal-title":"Teach Learn Med"},{"issue":"1","key":"10.1016\/j.jsurg.2026.104196_bib0016","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/ACM.0000000000000951","article-title":"Educating for the 21st-century Health Care System: an interdependent framework of basic, clinical, and systems sciences","volume":"92","author":"Gonzalo","year":"2017","journal-title":"Acad Med"},{"issue":"5","key":"10.1016\/j.jsurg.2026.104196_bib0017","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1097\/ACM.0000000000004598","article-title":"Evolving the systems-based practice competency in graduate medical education to meet patient needs in the 21st-century health care system","volume":"97","author":"Gonzalo","year":"2022","journal-title":"Acad Med"},{"issue":"3","key":"10.1016\/j.jsurg.2026.104196_bib0018","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1001\/jama.2012.7551","article-title":"Understanding health care as a complex system: the foundation for unintended consequences","volume":"308","author":"Lipsitz","year":"2012","journal-title":"JAMA"},{"issue":"7","key":"10.1016\/j.jsurg.2026.104196_bib0019","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.2105\/AJPH.2010.198176","article-title":"Systems science: a revolution in public health policy research","volume":"100","author":"Mabry","year":"2010","journal-title":"Am J Public Health"},{"issue":"2 Suppl","key":"10.1016\/j.jsurg.2026.104196_bib0020","doi-asserted-by":"crossref","first-page":"S211","DOI":"10.1016\/j.amepre.2008.05.018","article-title":"Interdisciplinarity and systems science to improve population health: a view from the NIH Office of Behavioral and Social Sciences Research","volume":"35","author":"Mabry","year":"2008","journal-title":"Am J Prev Med"},{"issue":"12","key":"10.1016\/j.jsurg.2026.104196_bib0021","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1111\/j.1553-2712.2011.01231.x","article-title":"Learning from accident and error: avoiding the hazards of workload, stress, and routine interruptions in the emergency department","volume":"18","author":"Morrison","year":"2011","journal-title":"Acad Emerg Med"},{"issue":"1","key":"10.1016\/j.jsurg.2026.104196_bib0022","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1186\/s12913-019-4627-7","article-title":"Mathematical modelling for health systems research: a systematic review of system dynamics and agent-based models","volume":"19","author":"Cassidy","year":"2019","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"10.1016\/j.jsurg.2026.104196_bib0023","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1186\/s12889-018-5318-8","article-title":"The application of system dynamics modelling to environmental health decision-making and policy: a scoping review","volume":"18","author":"Currie","year":"2018","journal-title":"BMC Public Health"},{"issue":"1","key":"10.1016\/j.jsurg.2026.104196_bib0024","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1002\/sdr.1646","article-title":"System dynamics modeling in health and medicine: a systematic literature review","volume":"36","author":"Darabi","year":"2020","journal-title":"Syst Dyn Rev"},{"issue":"10","key":"10.1016\/j.jsurg.2026.104196_bib0025","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1097\/ACM.0000000000004133","article-title":"The Association of American Medical Colleges\u2019 Local Area Physician Workforce Modeling Project","volume":"96","author":"Dill","year":"2021","journal-title":"Acad Med"},{"issue":"8","key":"10.1016\/j.jsurg.2026.104196_bib0026","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1377\/hlthaff.2015.1043","article-title":"Combined regional investments could substantially enhance health system performance and be financially affordable","volume":"35","author":"Homer","year":"2016","journal-title":"Health Aff (Millwood)"},{"issue":"5","key":"10.1016\/j.jsurg.2026.104196_bib0027","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.annemergmed.2008.07.009","article-title":"Adding more beds to the emergency department or reducing admitted patient boarding times: which has a more significant influence on emergency department congestion?","volume":"53","author":"Khare","year":"2009","journal-title":"Ann Emerg Med"},{"issue":"2","key":"10.1016\/j.jsurg.2026.104196_bib0028","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1023\/A:1023385019514","article-title":"Client involvement in simulation model building: hints and insights from a case study in a London hospital","volume":"6","author":"Lane","year":"2003","journal-title":"Health Care Manag Sci"},{"issue":"6","key":"10.1016\/j.jsurg.2026.104196_bib0029","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1136\/emj.2002.003673","article-title":"Reviewing emergency care systems I: insights from system dynamics modelling","volume":"21","author":"Lattimer","year":"2004","journal-title":"Emerg Med J"},{"issue":"23","key":"10.1016\/j.jsurg.2026.104196_bib0030","doi-asserted-by":"crossref","DOI":"10.1073\/pnas.2115714119","article-title":"Modeling the evolution of the US opioid crisis for national policy development","volume":"119","author":"Lim","year":"2022","journal-title":"Proc Natl Acad Sci USA"},{"issue":"4","key":"10.1016\/j.jsurg.2026.104196_bib0031","first-page":"733","article-title":"The dynamics of action-oriented problem solving: linking interpretation and choice","volume":"34","author":"Rudolph","year":"2009","journal-title":"Acad Manag Rev"},{"issue":"2","key":"10.1016\/j.jsurg.2026.104196_bib0032","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1213\/ANE.0000000000005040","article-title":"The tipping point of medical technology: implications for the postpandemic era","volume":"131","author":"Lu","year":"2020","journal-title":"Anesth Analg"},{"key":"10.1016\/j.jsurg.2026.104196_bib0033","unstructured":"Accreditation Council for Graduate Medical Education. Surgery milestones. January 2019. Available at: https:\/\/www.acgme.org\/globalassets\/PDFs\/Milestones\/SurgeryMilestones.pdf. Accessed August 17, 2026."}],"container-title":["Journal of Surgical Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1931720426003284?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1931720426003284?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:17:57Z","timestamp":1792149477000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1931720426003284"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,11]]},"references-count":33,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["S1931720426003284"],"URL":"https:\/\/doi.org\/10.1016\/j.jsurg.2026.104196","relation":{},"ISSN":["1931-7204"],"issn-type":[{"value":"1931-7204","type":"print"}],"subject":[],"published":{"date-parts":[[2026,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Viewing the Underperforming Trainee Using a System Dynamics Lens: Understanding the Impact of Interprofessional Interactions in a Healthcare System","name":"articletitle","label":"Article Title"},{"value":"Journal of Surgical Education","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jsurg.2026.104196","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Published by Elsevier Inc. on behalf of Association of Program Directors in Surgery.","name":"copyright","label":"Copyright"}],"article-number":"104196"}}