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Zeigler SM, Starnes SL, Sade RM. Should a questionably competent resident be allowed to continue in the program? J Thorac Cardiovasc Surg 2024; 167:283-288. [PMID: 36357222 DOI: 10.1016/j.jtcvs.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/27/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Sanford M Zeigler
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Sandra L Starnes
- Section of Cardiothoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Robert M Sade
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
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Santen SA, Hemphill RR. Embracing our responsibility to ensure trainee competency. AEM EDUCATION AND TRAINING 2023; 7:e10863. [PMID: 37013132 PMCID: PMC10066499 DOI: 10.1002/aet2.10863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Sally A. Santen
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Virginia Commonwealth University School of MedicineRichmondVirginiaUSA
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Schenarts PJ, Bourne J. Invited Response to The Inadvertent Personal Liability of Graduate Medical Education (ASU-21-0920-Letter to the Editor). Am Surg 2021; 87:1850. [PMID: 34758664 DOI: 10.1177/00031348211056280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Paul J Schenarts
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Jennifer Bourne
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
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Naftalovich R, Nalbone JM, Iskander AJ, Tewfik GL. Personal Liability of Residents, Attending Staff, and Training Programs in Graduate Medical Education. Am Surg 2021; 87:1848-1849. [PMID: 34734531 DOI: 10.1177/00031348211050836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rotem Naftalovich
- Department of Anesthesia and Perioperative Care, 12286Rutgers-New Jersey Medical School (NJMS), Newark, NJ, USA.,Medical Corps of the US Army, 51722US Army Medical Department, San Antonio, TX, USA
| | - Joseph M Nalbone
- Department of Anesthesia and Perioperative Care, 12286Rutgers-New Jersey Medical School (NJMS), Newark, NJ, USA
| | - Andrew J Iskander
- Rutgers - Robert Wood Johnson Medical School, 8138New Brunswick, NJ, USA
| | - George L Tewfik
- Department of Anesthesia and Perioperative Care, 12286Rutgers-New Jersey Medical School (NJMS), Newark, NJ, USA
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Schultz K, Risk A, Newton L, Snider N. Program foundations and beginning of concerns (part 1 of 3). When residents shouldn't become clinicians: getting a grip on fair and defensible processes for termination of training. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:116-120. [PMID: 34567312 PMCID: PMC8463223 DOI: 10.36834/cmej.70170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Training programs have the dual responsibility of providing excellent training for their learners and ensuring their graduates are competent practitioners. Despite everyone's best efforts a small minority of learners will be unable to achieve competence and cannot graduate. Unfortunately, program decisions for training termination are often overturned, not because the academic decision was wrong, but because fair assessment processes were not implemented or followed. This series of three articles, intended for those setting residency program assessment policies and procedures, outlines recommendations, from establishing robust assessment foundations and the beginning of concerns (Part One), to established concerns and formal remediation (Part Two) to participating in formal appeals and after (Part Three). With these 14 recommendations on how to get a grip on fair and defensible processes for termination of training, career-impacting decisions that are both fair for the learner and defensible for programs are indeed possible. They are offered to minimize the chances of academic decisions being overturned, an outcome which wastes program resources, poses patient safety risks, and delays the resident finding a more appropriate career path. This article (part one in the series of three) will focus on the foundational aspects of residency training and the emergence of concerns.
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Affiliation(s)
| | - Andrea Risk
- Cunningham, Swan, Carty, Little and Bonham LLP, Ontario, Canada
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Abstract
There are myriad types of problem learners in surgical residency and most have difficulty in more than 1 competency. Programs that use a standard curriculum of study and assessment are most successful in identifying struggling learners early. Many problem learners lack appropriate systems for study; a multidisciplinary educational team that is separate from the team that evaluates the success of remediation is critical. Struggling residents who require formal remediation benefit from performance improvement plans that clearly outline the issues of concern, describe the steps required for remediation, define success of remediation, and outline consequences for failure to remediate appropriately.
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Affiliation(s)
- Lilah F Morris-Wiseman
- University of Arizona, Department of Surgery, Division of Surgical Oncology, 1501 N. Campbell Avenue, PO Box 245058, Tucson, AZ 85724-5058, USA
| | - Valentine N Nfonsam
- University of Arizona, Department of Surgery, Division of Surgical Oncology, 1501 N. Campbell Avenue, PO Box 245058, Tucson, AZ 85724-5058, USA.
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To H, Cargill A, Tobin S, Nestel D. Remediation of Underperformance in Surgical Trainees - A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2021; 78:1111-1122. [PMID: 33139216 DOI: 10.1016/j.jsurg.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/14/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Surgical trainees with significant underperformance require formal support to return to an expected standard, termed remediation. The aim of this scoping review was to define remediation interventions, approaches, and contexts. DESIGN Following scoping review protocols, we set out to identify the evidence-base for remediation of surgical trainees, outline key concepts and uncover areas to stimulate further research. RESULTS From a screen of 80 articles, 24 reported on remediation of surgical trainees. Most were from medical journals (n = 21, 88%) and published in the United States (n = 20, 83%). Ten articles (41%) reported outcomes of remediation of a trainee cohort and 7 (19%) were survey reports from surgical directors. The remainder were a mix of commentaries, editorials or reviews. Thirteen articles (54%) described trainees with deficiencies in multiple competencies, 8 articles (33%) had a singular focus on academic performance, and 1 article (3%) on technical skills. All articles used targeted individualized remediation strategies, a range of intervention methods (some multimodal) and recommended a 6- to 12-month period of remediation (n = 7, 29%). The program director was often the only supervisor (n = 12, 50%). One article reported trainees' perspective of the process and one used educational theory to inform remediation. CONCLUSIONS Data with clearly reported outcomes were limited, but we found that targeted, individualized, multimodal and long-term remediation covering a range of competencies have been reported in the literature for surgical trainees. There is a need for development of explicit frameworks, strengthen the support for supervisors and trainees and further apply educational theory to develop better interventions that remediate deficiencies for all competencies.
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Affiliation(s)
- Henry To
- University of Melbourne, Parkville, Australia.
| | | | - Stephen Tobin
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Debra Nestel
- Department of Surgery (Austin), University of Melbourne, Heidelberg, Australia; Monash Institute for Health & Clinical Education, Monash University, Clayton, Australia
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Bartley GB. Verifying Surgical Competence: Our Fiduciary Responsibility. Ophthalmology 2020; 127:997-999. [PMID: 32703391 DOI: 10.1016/j.ophtha.2020.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/18/2020] [Indexed: 10/23/2022] Open
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Crannell WC, Brasel KJ. Dealing with the struggling learner. Surgery 2020; 167:523-527. [DOI: 10.1016/j.surg.2019.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/21/2019] [Accepted: 06/04/2019] [Indexed: 11/17/2022]
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Hellwig T, Williams CR, Jen C, Raub JN, Scalese M, Smith WJ, Parbuoni KA. Current practices for identifying and managing challenging pharmacy residents: A needs assessment. Am J Health Syst Pharm 2020; 77:52-55. [DOI: 10.1093/ajhp/zxz257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thaddaus Hellwig
- South Dakota State University, College of Pharmacy and Allied Health Professions, Sioux Falls, SD
- Sanford USD Medical Center, Sioux Falls, SD
| | - Charlene R Williams
- Eshelman School of Pharmacy, University of North Carolina Chapel Hill, Asheville, NC
| | - Christi Jen
- HonorHealth Deer Valley Medical Center, Phoenix, AZ
- Department of Pharmacy Practice, University of Arizona College of Pharmacy, Phoenix, AZ
| | - Joshua N Raub
- Department of Pharmacy Services, Detroit Receiving Hospital, Detroit, MI
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Michael Scalese
- Department of Pharmacy Practice, Prisma Health Richland, Columbia, SC
| | - Winter J Smith
- Department of Clinical Sciences, Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, TX
| | - Kristine A Parbuoni
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
- University of Maryland Medical Center, Baltimore, MD
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Moffett P. Standardized Letters of Concern and Remediation Contracts: Templates for Program Directors. J Grad Med Educ 2019; 11:606-610. [PMID: 31636834 PMCID: PMC6795327 DOI: 10.4300/jgme-d-19-00065.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/21/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Remediation of the struggling resident is a universal phenomenon, and the majority of program directors will remediate at least 1 resident during their tenure. OBJECTIVE The goal of this project was to create a standardized template for program directors to use at all stages of remediation. METHODS Between 2017 and 2018, the Council of Residency Directors in Emergency Medicine (CORD-EM) Remediation Committee searched for best practices in the medical literature and compiled a survey that was e-mailed to the CORD-EM listserv. After reviewing all information, a standardized remediation contract was created, reviewed by legal counsel, and distributed to members. RESULTS Forty-two percent (110 of 263) of program directors or assistant program directors on the CORD-EM listserv answered the initial survey and provided guidance on current remediation practices. The committee created formal and informal standard remediation contracts as both fillable templates and alterable documents. These were reviewed by CORD-EM general legal counsel and approved by the CORD-EM Board of Directors for distribution. The project took approximately 20 hours to complete over 8 months and involved a cost of $480 for legal fees. CONCLUSIONS With program director input and legal counsel review, the CORD-EM Remediation Committee produced standardized remediation contracts, which can be used by all emergency medicine programs after comparison to local institutional policy and local legal review. This process was feasible and can be replicated by other specialties.
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Tiong JJL, Kho HL, Mai CW, Lau HL, Hasan SS. Academic dishonesty among academics in Malaysia: a comparison between healthcare and non-healthcare academics. BMC MEDICAL EDUCATION 2018; 18:168. [PMID: 30016945 PMCID: PMC6050687 DOI: 10.1186/s12909-018-1274-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 07/10/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study was carried out to gauge the prevalence of academic dishonesty among academics in Malaysian universities. A direct comparison was made between academics of healthcare and non-healthcare courses to note the difference in the level of academic integrity between the two groups. In addition, the predisposing factors and implications of academic dishonesty, as well as the different measures perceived to be effective at curbing this problem were also investigated. METHODS A cross-sectional study design with mixed qualitative and quantitative approaches was employed and data collection was carried out primarily using self-administered questionnaire. RESULTS Approximately half (52.5%, n = 74) of all respondents (n = 141) reported having personally encountered at least one case of academic dishonesty involving their peers. The results also revealed the significantly higher prevalence of various forms of academic misconduct among healthcare academics compared to their non-healthcare counterparts. Although respondents were generally conscious of the negative implications associated with academic dishonesty, more than half of all cases of misconduct were not reported due to the indifferent attitude among academics. Low levels of self-discipline and integrity were found to be the major factors leading to academic misdeeds and respondents opined that university managements should be more proactive in addressing this issue. CONCLUSIONS The outcome of this study should serve as a clarion call for all relevant stakeholders to start making immediate amends in order to improve the current state of affairs in academia.
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Affiliation(s)
- John Jeh Lung Tiong
- 0000 0004 0647 0003grid.452879.5School of Pharmacy, Taylor’s University, No. 1, Jalan Taylor’s, 47500 Subang Jaya, Selangor Malaysia
| | - Hui Ling Kho
- 0000 0004 0647 0003grid.452879.5School of Pharmacy, Taylor’s University, No. 1, Jalan Taylor’s, 47500 Subang Jaya, Selangor Malaysia
| | - Chun-Wai Mai
- 0000 0000 8946 5787grid.411729.8School of Pharmacy, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur Malaysia
| | - Hui Ling Lau
- 0000 0004 0647 0003grid.452879.5School of Pharmacy, Taylor’s University, No. 1, Jalan Taylor’s, 47500 Subang Jaya, Selangor Malaysia
| | - Syed Shahzad Hasan
- 0000 0000 8946 5787grid.411729.8School of Pharmacy, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur Malaysia
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