In my setting, here are a few of the challenges I've encountered:
1. Conflicts among the different goals of the training institution -- My institution aims to excel in training, research, and service. Ideally, these should be integrated harmoniously, but in reality the situation is fraught with conflicts. The time that a resident has to devote to training is time away from his research requirements. Many responsibilities don't have allotted time carved out in the work day; For example, a resident may be decked diagnostic examinations for official reading (primarily a service activity), but his full-day schedule is already allotted to surgical assists (primarily a training activity). This leads to backlogs that pile up quickly.
2. Clinic logistics, mainly electronic medical records -- The RADISH EMR used at the Philippine General Hospital and the fluctuating internet service during clinic hours are a source of daily problems and constant delays. The EMR is not intuitive and not user-friendly, especially for clinics that employ many diagrams in recording the physical examination. Access to medical records is also difficult as passwords are changed often but not provided in a timely manner.
3. Low morale - Mental health has been a constant and major concern among our trainees in recent years. This deters teachers and fellow trainees from giving feedback, no matter how constructive. The result is acceptance of mediocre performance.