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Han DS, Badalato GM, Murano TE, Anderson CB. Resident Remediation: A National Survey of Urology Program Directors. JOURNAL OF SURGICAL EDUCATION 2024; 81:465-473. [PMID: 38383239 DOI: 10.1016/j.jsurg.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/22/2023] [Indexed: 02/23/2024]
Abstract
OBJECTIVES To describe formal remediation rates and processes in urology training programs nationally. DESIGN, SETTING, AND PARTICIPANTS We performed a cross-sectional study by surveying program directors (PDs) through the Society of Academic Urologists. Formal remediation was defined as the process initiated when resident competency deficiencies were significant enough to necessitate documentation and notification of the Graduate Medical Education (GME) office. The primary outcome was the prevalence of urology programs that initiated formal remediation over the past 5 years. Secondary outcomes included reported competency deficiencies and formal remediation processes. RESULTS Across 148 institutions, 73 (49%) PDs responded to the survey. The majority of PDs (67%, 49/73) stated that at least 1 resident underwent formal remediation over the last 5 years (median 1). "Professionalism" and "Interpersonal and Communication Skills" were the most common competency deficiencies that prompted formal remediation, whereas "Technical Skill" was the least common. While the majority of respondents notified the GME office of residents undergoing remediation, formal remediation plans varied from faculty coaching and mentorship (80%, 39/49) to simulation training (10%, 5/49). Absence of documented faculty feedback on poor performance was the most commonly cited barrier to formal remediation. The majority of PDs reported documentation in a resident's file (81%, 59/73); however, remediation processes differed with only half of PDs reporting that GME offices were routinely involved in creating and overseeing corrective action plans (56%, 41/73). Over the study period, 15% (11/73) of PDs did not promote a resident to the next year of training, and 23% (17/73) of PDs stated "Yes" to graduating a resident who they would not trust to care for a loved one. CONCLUSIONS Formal remediation among urology residency programs is common, and processes vary across institutions. The most common competency areas prompting remediation were "Professionalism" and "Interpersonal and Communication Skills." Future research should address developing resources to facilitate resident remediation.
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Affiliation(s)
- David S Han
- Columbia University Irving Medical Center, Department of Urology, New York, New York.
| | - Gina M Badalato
- Columbia University Irving Medical Center, Department of Urology, New York, New York
| | - Tiffany E Murano
- Columbia University Irving Medical Center, Department of Emergency Medicine, New York, New York
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Plewa MC, Ledrick DJ, Jenkins K, Orqvist A, McCrea M. Can USMLE and COMLEX-USA Scores Predict At-Risk Emergency Medicine Residents' Performance on In-Training Examinations? Cureus 2024; 16:e58684. [PMID: 38651085 PMCID: PMC11033967 DOI: 10.7759/cureus.58684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE The United States Medical Licensing Examination (USMLE) and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) scores are standard methods used to determine residency candidates' medical knowledge. The authors were interested in using the USMLE and COMLEX part 2 scores in our emergency medicine (EM) residency program to identify at-risk residents who may have difficulty on the in-training exam (ITE) and to determine the cutoff values under which an intern could be given an individualized study plan to ensure medical knowledge competency. METHODS The authors abstracted the USMLE and COMLEX part 2 scores and the American Board of Emergency Medicine (ABEM) ITE scores for a cohort of first-year EM residents graduating years 2010-2022, converting raw scores to percentiles, and compared part 2 and ABEM ITE scores with Pearson's correlation, a Bland-Altman analysis of bias and 95% limits of agreement, and ROC analysis to determine optimal the cut-off values for predicting ABEM ITE < 50th percentile and the estimated test characteristics. RESULTS Scores were available for 152 residents, including 93 USMLE and 88 COMLEX exams. The correlations between part 2 scores and ABEM ITE were r = 0.36 (95%CI: 0.17, 0.52; p < 0.001) for USMLE and r = 0.50 (95%CI: 0.33, 0.64; p < 0.001) for COMLEX. Bias and limits of agreement for both part 2 scores were -14 ± 63% for USMLE and 13 ± 50% for COMLEX in predicting the ABEM ITE scores. USMLE < 37th percentile and COMLEX < 53rd percentile identified 42% (N = 39) and 27% (N = 24) of EM residents, respectively, as at risk, with a sensitivity of 61% and 49% and specificity of 71% and 92%, respectively. CONCLUSION USMLE and COMLEX part 2 scores have a very limited role in identifying those at risk of low ITE performance, suggesting that other factors should be considered to identify interns in need of medical knowledge remediation.
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Affiliation(s)
- Michael C Plewa
- Emergency Medicine, Mercy Health - St. Vincent Medical Center, Toledo, USA
| | - David J Ledrick
- Emergency Medicine, Mercy Health - St. Vincent Medical Center, Toledo, USA
| | - Kenneth Jenkins
- Emergency Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, USA
| | - Aaron Orqvist
- Emergency Medicine, Mercy Health - St. Vincent Medical Center, Toledo, USA
| | - Michael McCrea
- Emergency Medicine, Mercy Health - St. Vincent Medical Center, Toledo, USA
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Godschalx-Dekker JA, Gerritse FL, Pronk SA, Duvivier RJ, van Mook WNKA. Is insufficient introspection a reason to terminate residency training? - Scrutinising introspection among residents who disputed dismissal. MEDICAL TEACHER 2024:1-8. [PMID: 38506085 DOI: 10.1080/0142159x.2024.2323175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Insufficient introspection as part of the 4I's model of medical professionalism (introspection, integrity, interaction, and involvement) is considered an important impediment in trainees. How insufficient introspection relates to decisions to terminate residency training remains unclear. Insights into this subject provide opportunities to improve the training of medical professionals. METHODS We analysed the Dutch Conciliation Board decisions regarding residents dismissed from training between 2011 and 2020. We selected the decisions on residents deemed 'insufficient' regarding introspection as part of the CanMEDS professional domain and compared their characteristics with the decisions about residents without reported insufficiencies on introspection. RESULTS Of the 120 decisions, 86 dismissed residents were unable to fulfil the requirements of the CanMEDS professional domain. Insufficient introspection was the most prominent insufficiency (73/86). These 73 decisions described more residents' insufficiencies in CanMEDS competency domains compared to the rest of the decisions (3.8 vs. 2.7 p < 0.001), without significant differences regarding gender or years of training. CONCLUSIONS Insufficient introspection in residents correlates with competency shortcomings programme directors reported in dismissal disputes. The 4I's model facilitates recognition and description of unprofessional behaviours, opening avenues for assessing and developing residents' introspection, but further research is needed for effective implementation in medical education.
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Affiliation(s)
| | - Frank L Gerritse
- Department of Hospital Psychiatry, Tergooi MC, Hilversum, The Netherlands
| | - Sebastiaan A Pronk
- Academy for Postgraduate Medical Training, Maastricht UMC+, Maastricht, The Netherlands
| | - Robbert J Duvivier
- Center for Education Development And Research in Health Professions (CEDAR), UMC Groningen, Groningen, The Netherlands
- Emergency Services, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Walther N K A van Mook
- Academy for Postgraduate Medical Training, Maastricht UMC+, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht UMC+, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Godschalx-Dekker JA, Sijbom CAM, Barnhoorn PC, van Mook WNKA. Unprofessional behaviour of GP residents leading to a dismissal dispute: characteristics and outcomes of those who appeal. BMC PRIMARY CARE 2024; 25:61. [PMID: 38378463 PMCID: PMC10877848 DOI: 10.1186/s12875-024-02294-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Recognition of poor performance in General Practice trainees is important because underperformance compromises patients' health and safety. However, in General Practice, research on persistent underperformance while in training and its ultimate consequences is almost completely lacking. We aim to explore the unprofessional behaviours of residents in General Practice who were dismissed from training and who litigated against dismissal. METHODS We performed a structured analysis using open-source data from all General Practice cases before the Conciliation Board of the Royal Dutch Medical Association between 2011 and 2020. Anonymised law cases about residents from all Dutch GP training programmes were analysed in terms of the quantitative and qualitative aspects related to performance. RESULTS Between 2011 and 2020, 24 residents who were dismissed from training challenged their programme director's decision. Dismissed residents performed poorly in several competencies, including communication, medical expertise and most prominently, professionalism. Over 90% of dismissed residents failed on professionalism. Most lacked self-awareness and/or failed to profit from feedback. Approximately 80% failed on communication, and about 60% on medical expertise as well. A large majority (more than 80%) of dismissed residents had previously participated in some form of remediation. CONCLUSIONS Deficiencies in both professionalism and communication were the most prevalent findings among the dismissed General Practice residents. These two deficiencies overlapped considerably. Dismissed residents who challenged their programme director's decision were considered to lack self-awareness, which requires introspection and the appreciation of feedback from others.
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Affiliation(s)
- Judith A Godschalx-Dekker
- Department of Psychiatry and Medical Psychology Flevoziekenhuis, Almere, The Netherlands
- GGZ Central Flevoland, Almere, The Netherlands
| | | | - Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht UMC+, Maastricht, The Netherlands.
- Academy for Postgraduate Training, Maastricht UMC+, Maastricht, The Netherlands.
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
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Godschalx-Dekker J, van Mook W. Dutch dismissal practices: characteristics, consequences, and contrasts in residents' case law in community-based practice versus hospital-based specialties. BMC MEDICAL EDUCATION 2024; 24:160. [PMID: 38374054 PMCID: PMC10877891 DOI: 10.1186/s12909-024-05106-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 01/28/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND In the Netherlands, 2 to 10% of the residents terminate training prematurely. Infrequently, termination of training is by dismissal. Incidentally, residents may disagree, dispute and challenge these decisions from the programme directors. Resident dismissal is always a difficult decision, most commonly made after, repeated assessments, and triangulation of the resulting assessment data and one or more remediation attempts. Nevertheless, the underlying reasons for dismissal and the policies for remediation and dismissal may differ between training programmes. Such differences may however impact the chance of remediation success, the chance of dismissal and subsequent residents' appeals. METHOD We included a total of 70 residents from two groups (community-based and hospital-based specialties) during 10 years of appeals. Subsequently, we compared these groups on factors potentially associated with the outcome of the conciliation board decision regarding the residents' dismissal. We focused herein on remediation strategies applied, and reasons reported to dismiss residents. RESULTS In both groups, the most alleged reason to dismiss residents was lack of trainability, > 97%. This was related to deficiencies in professionalism in community-based practice and medical expertise in hospital-based specialties respectively. A reason less frequently mentioned was endangerment of patient care, < 26%. However, none of these residents accused of endangerment, actually jeopardized the patients' health, probably due to the vigilance of their supervisors. Remediation strategies varied between the two groups, whereas hospital-based specialties preferred formal remediation plans in contrast to community-based practice. A multitude of remediation strategies per competency (medical expertise, professionalism, communication, management) were applied and described in these law cases. DISCUSSION Residents' appeals in community-based practice were significantly less likely to succeed compared to hospital-based specialties. Hypothesised explanatory factors underlying these differences include community-based practices' more prominent attention to the longitudinal assessment of professionalism, the presence of regular quarterly progress meetings, precise documentation of deficiencies, and discretion over the timing of dismissal in contrast to dismissal in the hospital-based specialties which is only formally possible during scheduled formal summative assessment meetings.
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Affiliation(s)
- Judith Godschalx-Dekker
- Department of Psychiatry and Medical Psychology, GGZ Central, Flevoziekenhuis, Almere, The Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Academy for Postgraduate Training, Maastricht UMC+, and School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
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Godschalx-Dekker JA, Gerritse FL, van Mook WNKA, Luykx JJ. Do deficiencies in CanMEDS competencies of dismissed residents differ according to specialty? MEDICAL TEACHER 2023; 45:772-777. [PMID: 36652604 DOI: 10.1080/0142159x.2023.2166477] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Program directors dismiss a small percentage of residents from residency training programs, presumably due to underperformance or lack of progress. Whether underperformance in competency domains differs by residents' specialty is unknown. METHODS In 2021, we analysed the case law of Dutch residents who were dismissed from training by the program director, and who challenged this dismissal before the national conciliation board between 2011 and 2020. Across medical specialties we compared which of the CanMEDS competency domains these residents failed to meet. RESULTS We found 116 cases of residents dismissed from their training programmes who challenged the decision of the program director before the board. In general, most residents were unable to meet the requirements of several CanMEDS competency domains (usually: medical expert, communicator, and professional). In surgery, all dismissed residents failed to meet the competency domain of the medical expert, while most of the dismissed psychiatry residents met this domain. In specialties with a primarily diagnostic task, more dismissed residents failed to meet the competency domain of the scholar, while dismissed general medicine residents (for example family medicine and nursing homecare) were less likely to do so. Residents in general medicine, more often than other specialties, however, failed to meet the competency domain of the professional. CONCLUSION Residents dismissed from training, who challenged their dismissal, failed to meet the requirements of multiple CanMEDS competency domains. Competency domain failures differ by specialty.
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Affiliation(s)
- Judith A Godschalx-Dekker
- Department of Hospital Psychiatry and Medical Psychology, Flevoziekenhuis Almere, The Netherlands
- Department of Psychiatry St. Jansdal, Lelystad, The Netherlands
- GGZ Central, Flevoland, The Netherlands
| | - Frank L Gerritse
- Department of Hospital Psychiatry, Tergooi MC, Blaricum, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Academy for Postgraduate Training, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Jurjen J Luykx
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
- GGNet Mental Health, Warnsveld, The Netherlands
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Shaker L, Amilcar C, Kothari N, Murano T. KNOWLEDGE, ATTITUDES AND PERCEPTIONS OF REMEDIATION AMONG TRAINEES IN GRADUATE MEDICAL EDUCATION PROGRAMS. J Emerg Med 2023; 65:e41-e49. [PMID: 37355420 DOI: 10.1016/j.jemermed.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/06/2023] [Accepted: 04/10/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Remediation of medical trainees is a universal challenge, yet studies show that many residents will need remediation to improve performance. Current literature discusses the importance and processes of remediation and investigates how to recognize residents needing remediation. However, little is known about trainees' attitudes and perception of remediation. OBJECTIVES To assess trainees' knowledge of remediation as well as their attitudes and perceptions toward remediation and its process. We hypothesized that trainees have limited knowledge and a negative perception of remediation. METHODS A cross-sectional anonymous electronic survey was sent to all graduate medical education trainees at a single institution. RESULTS The survey was completed by 132/1095 (12.1%) trainees. Of the respondents, 7.6% were not familiar with the term "remediation." Trainees' knowledge of remediation processes was variable, and they reported overwhelmingly negative thoughts and attitudes toward remediation. Shame was felt by 97/132 (73.5%), 71/132 (53.8%) felt disadvantaged, and 121/132 (91.7%) viewed the term "remediation" negatively. Most trainees felt using a more positive term would improve perceptions, and 124/132 (93.9%) felt residents should be involved in creating individualized remediation plans. Open-ended responses on reactions to being placed on remediation included disappointment, shame, incompetency, anxiety and worry, embarrassment, unhappiness, suicidality, worthlessness, sense of failure, and doubting one's capabilities as a physician. CONCLUSION Trainees have limited knowledge and understanding of remediation and strong negative perceptions and attitudes toward the remediation process. Trainees suggested that reframing of remediation using more positive terminology and including residents in creating individualized plans, may improve attitudes and perceptions of this process.
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Affiliation(s)
- Lana Shaker
- Hackensack University Medical Center, Hackensack, New Jersey
| | - Cindy Amilcar
- Department of Emergency Medicine, University of Texas Health-McGovern Medical School, Houston, Texas
| | - Neil Kothari
- Office of Graduate Medical Education, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Tiffany Murano
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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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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Cheong CWS, Quah ELY, Chua KZY, Lim WQ, Toh RQE, Chiang CLL, Ng CWH, Lim EG, Teo YH, Kow CS, Vijayprasanth R, Liang ZJ, Tan YKI, Tan JRM, Chiam M, Lee ASI, Ong YT, Chin AMC, Wijaya L, Fong W, Mason S, Krishna LKR. Post graduate remediation programs in medicine: a scoping review. BMC MEDICAL EDUCATION 2022; 22:294. [PMID: 35443679 PMCID: PMC9020048 DOI: 10.1186/s12909-022-03278-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the 'deliberate practice of improving performance through practising beyond one's comfort level under guidance'. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs. METHODS Krishna's Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA's Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions. RESULTS The research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs. CONCLUSION Building upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy's Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation's role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development.
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Affiliation(s)
- Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Wei Qiang Lim
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Christine Li Ling Chiang
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Caleb Wei Hao Ng
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Elijah Gin Lim
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Cheryl Shumin Kow
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Raveendran Vijayprasanth
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Zhen Jonathan Liang
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Yih Kiat Isac Tan
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Javier Rui Ming Tan
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Blk MD6, Centre, 14 Medical Dr, #05-01 for Translational Medicine, Singapore, 117599 Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854 Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597 Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436 Singapore
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Walwyn S, Barrie J. Trainees requiring extra support. BJA Educ 2022; 22:67-74. [PMID: 35035995 PMCID: PMC8749380 DOI: 10.1016/j.bjae.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- S. Walwyn
- Pinderfields Hospital, Wakefield, UK,Corresponding author:
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Jewell C, Kraut A, Miller D, Ray K, Werley E, Schnapp B. Metrics of Resident Achievement for Defining Program Aims. West J Emerg Med 2022; 23:1-8. [PMID: 35060852 PMCID: PMC8782131 DOI: 10.5811/westjem.2021.12.53554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Resident achievement data is a powerful but underutilized means of program evaluation, allowing programs to empirically measure whether they are meeting their program aims, facilitate refinement of curricula and improve resident recruitment efforts. The goal was to provide an overview of available metrics of resident achievement and how these metrics can be used to inform program aims. Methods A literature search was performed using PubMed and Google Scholar between May and November of 2020. Publications were eligible for inclusion if they discussed or assessed “excellence” or “success” during residency training. A narrative review structure was chosen due to the intention to provide an examination of the literature on available resident achievement metrics. Results 57 publications met inclusion criteria and were included in the review. Metrics of excellence were grouped into larger categories, including success defined by program factors, academics, national competencies, employer factors, and possible new metrics. Conclusions Programs can best evaluate whether they are meeting their program aims by creating a list of important resident-level metrics based on their stated goals and values using one or more of the published definitions as a foundation. Each program must define which metrics align best with their individual program aims and mission.
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Affiliation(s)
- Corlin Jewell
- University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin
| | - Aaron Kraut
- University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin
| | - Danielle Miller
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Kaitlin Ray
- University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin
| | - Elizabeth Werley
- PennState College of Medicine, Department of Emergency Medicine, Hershey, Pennsylvania
| | - Bejamin Schnapp
- University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin
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Graduate Medical Education “Trainee in difficulty” current remediation practices and outcomes. Am J Surg 2021; 224:796-808. [DOI: 10.1016/j.amjsurg.2021.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/23/2022]
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Price T, Brennan N, Wong G, Withers L, Cleland J, Wanner A, Gale T, Prescott-Clements L, Archer J, Bryce M. Remediation programmes for practising doctors to restore patient safety: the RESTORE realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
An underperforming doctor puts patient safety at risk. Remediation is an intervention intended to address underperformance and return a doctor to safe practice. Used in health-care systems all over the world, it has clear implications for both patient safety and doctor retention in the workforce. However, there is limited evidence underpinning remediation programmes, particularly a lack of knowledge as to why and how a remedial intervention may work to change a doctor’s practice.
Objectives
To (1) conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety; and (2) provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors.
Design
A realist review of the literature underpinned by the Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Searches of bibliographic databases were conducted in June 2018 using the following databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Education Resources Information Center, Database of Abstracts of Reviews of Effects, Applied Social Sciences Index and Abstracts, and Health Management Information Consortium. Grey literature searches were conducted in June 2019 using the following: Google Scholar (Google Inc., Mountain View, CA, USA), OpenGrey, NHS England, North Grey Literature Collection, National Institute for Health and Care Excellence Evidence, Electronic Theses Online Service, Health Systems Evidence and Turning Research into Practice. Further relevant studies were identified via backward citation searching, searching the libraries of the core research team and through a stakeholder group.
Review methods
Realist review is a theory-orientated and explanatory approach to the synthesis of evidence that seeks to develop programme theories about how an intervention produces its effects. We developed a programme theory of remediation by convening a stakeholder group and undertaking a systematic search of the literature. We included all studies in the English language on the remediation of practising doctors, all study designs, all health-care settings and all outcome measures. We extracted relevant sections of text relating to the programme theory. Extracted data were then synthesised using a realist logic of analysis to identify context–mechanism–outcome configurations.
Results
A total of 141 records were included. Of the 141 studies included in the review, 64% related to North America and 14% were from the UK. The majority of studies (72%) were published between 2008 and 2018. A total of 33% of articles were commentaries, 30% were research papers, 25% were case studies and 12% were other types of articles. Among the research papers, 64% were quantitative, 19% were literature reviews, 14% were qualitative and 3% were mixed methods. A total of 40% of the articles were about junior doctors/residents, 31% were about practicing physicians, 17% were about a mixture of both (with some including medical students) and 12% were not applicable. A total of 40% of studies focused on remediating all areas of clinical practice, including medical knowledge, clinical skills and professionalism. A total of 27% of studies focused on professionalism only, 19% focused on knowledge and/or clinical skills and 14% did not specify. A total of 32% of studies described a remediation intervention, 16% outlined strategies for designing remediation programmes, 11% outlined remediation models and 41% were not applicable. Twenty-nine context–mechanism–outcome configurations were identified. Remediation programmes work when they develop doctors’ insight and motivation, and reinforce behaviour change. Strategies such as providing safe spaces, using advocacy to develop trust in the remediation process and carefully framing feedback create contexts in which psychological safety and professional dissonance lead to the development of insight. Involving the remediating doctor in remediation planning can provide a perceived sense of control in the process and this, alongside correcting causal attribution, goal-setting, destigmatising remediation and clarity of consequences, helps motivate doctors to change. Sustained change may be facilitated by practising new behaviours and skills and through guided reflection.
Limitations
Limitations were the low quality of included literature and limited number of UK-based studies.
Future work
Future work should use the recommendations to optimise the delivery of existing remediation programmes for doctors in the NHS.
Study registration
This study is registered as PROSPERO CRD42018088779.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Jennifer Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Amanda Wanner
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Thomas Gale
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Julian Archer
- Medicine, Nursing and Health Sciences Education Portfolio, Monash University, Melbourne, VIC, Australia
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
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Ismailov RM, Saenz DT, Gascon P, Nucci M, Khasanova ZD. Improving awareness of several combination therapies for acute myeloid leukemia among oncology and hematology team members in Colorado, USA. Hematol Transfus Cell Ther 2021; 44:358-364. [PMID: 33622645 PMCID: PMC9477762 DOI: 10.1016/j.htct.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/23/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Although several combination therapies for acute myeloid leukemia (AML) have emerged recently, there has been a lack of published surveys and educational projects focused on these important treatment options. We aimed to improve the oncology team members' knowledge and awareness of several FDA approved combination therapies for AML, including glasdegib (DAURISMO®), venetoclax (VENCLEXTA®), GO (MYOLOTARG®),CPX-351 (VYXEOS®), and midostaurin (RYDAPT®). Additionally, we aimed to examine these teams' perspectives, views, and attitudes towards these topics and finally identify barriers to the implementationof such therapies in clinical practice. METHOD Initially, we developed booklets and then distributed them to each participating oncology and hematology office. Subsequently, all participating oncology and hematology team members were asked to complete an anonymous online survey to test their knowledge of and attitudes toward the subjects. MAIN RESULTS There was a total of 52 survey respondents. The correct answer regarding various combination therapies for AML was identified by nearly 70% or more of survey takers. The level of awareness of project subjects significantly improved after reading our printing materials. Many survey respondents were motivated to learn more about combination therapies for AML as well as discuss these topics with others. CONCLUSIONS Our booklets effectively improved understanding and awareness of combination therapies for AML. Future studies should explore awareness, knowledge, and perception of other new and emerging combination therapies for AML among oncology and hematology team members in other areas.
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Affiliation(s)
- Rovshan M Ismailov
- Complex Mechanisms of Disease, Aging and Trauma (CMDAT) Research Foundation, Denver, CO, United States.
| | - Dyana T Saenz
- The University of Texas M.D. Anderson Cancer Center, Houston TX, United States
| | - Pere Gascon
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Marcio Nucci
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Zaytuna D Khasanova
- Complex Mechanisms of Disease, Aging and Trauma (CMDAT) Research Foundation, Denver, CO, United States
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Principles of Remediation for the Struggling Neurosurgery Resident. World Neurosurg 2020; 146:e1118-e1125. [PMID: 33253950 DOI: 10.1016/j.wneu.2020.11.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND When resident physicians fail to demonstrate appropriate milestone competencies early in their neurologic surgery residency, a plan of remediation is necessary. METHODS Once any psychologic, physical, or behavioral causes of identified knowledge or psychomotor deficiencies have been identified and addressed, the next step is to develop a plan to close these gaps. Specific areas that are assessed for deficits include medical knowledge, clinical reasoning and judgment, clinical skills, time management and organization, interpersonal skills, communication, and professionalism. Specific learning goals and objectives, as well as teaching and learning methods, pertain to the unique areas of deficit, and all of these must be considered with the goal of developing a resident-specific remediation plan. RESULTS A plan for assessment of the remediation process is described, including an evaluation of what constitutes individual resident remediation success. CONCLUSIONS Finally, a discussion of the prior resident remediation studies across many disciplines is made.
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Ismailov RM, Pouillon L, Selinger CP, Khasanova ZD. Knowledge and awareness of biosimilars and shared decision-making among gastroenterology team members in Colorado, USA. Expert Opin Biol Ther 2020; 21:111-119. [PMID: 33107355 DOI: 10.1080/14712598.2020.1842355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: There are gaps in gastroenterologist team members' understanding of various topics related to biosimilars. We aimed to examine perspectives, views, and attitudes toward biosimilar and shared decision-making (SDM) among gastroenterology team members in Colorado, USA. The ultimate goal was to increase knowledge and awareness of biosimilars and SDM. Research design and methods: We developed educational materials focused on biosimilars and SDM and distributed them to each participating gastroenterology office. Subsequently, we conducted a survey of all team members from participating offices. Results: Responses were obtained from 54 gastroenterology team members. Most respondents identified the correct answer regarding biosimilars, the nocebo effect, and SDM. Almost half (47.2%) of respondents scored their level of awareness regarding biosimilars prior to reading our educational materials as poor, and nearly one quarter (26.4%) indicated so for SDM. Improvement in scores after reading our materials was significant for both biosimilars and SDM (i.e. biosimilar: z = 6.276, p-value <0.001 and SDM z = 6.328, p-value <0.001). Conclusions: Educational efforts effectively increased the low baseline knowledge and awareness of biosimilars and SDM among gastroenterology team members. More educational projects focused on biosimilars and SDM are needed to reduce the nocebo effect and prevent hampering of the cost-savings of biosimilars.
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Affiliation(s)
- Rovshan M Ismailov
- Complex Mechanisms of Disease, Aging and Trauma (CMDAT) Research Foundation , Denver, CO, USA
| | - Lieven Pouillon
- Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden , Bonheiden, Belgium
| | - Christian P Selinger
- Gastroenterology, Leeds Teaching Hospitals NHS Trust , Leeds, UK.,University of Leeds , Leeds, UK
| | - Zaytuna D Khasanova
- Complex Mechanisms of Disease, Aging and Trauma (CMDAT) Research Foundation , Denver, CO, USA
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Olson AS, Williamson K, Hartman N, Cheema N, Olson N. The Correlation Between Emergency Medicine Residents' Grit and Achievement. AEM EDUCATION AND TRAINING 2020; 4:24-29. [PMID: 31989067 PMCID: PMC6965685 DOI: 10.1002/aet2.10399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/23/2019] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Early identification of emergency medicine (EM) residents who struggle with educational attainment is difficult. In-training examination (ITE) scores predict success on the American Board of Emergency Medicine (ABEM) Qualifying Examination; however, results are not available until late in the academic year. The noncognitive trait "grit," defined as "perseverance and passion for long-term goals," predicts achievement in high school graduation rates, undergraduate GPA, and gross anatomy. Grit-S is a validated eight-question scale scored 1 to 5; the average of responses represents a person's grit. Our objective was to determine the correlation between EM resident Grit-S scores and achievement, as measured by MCAT percentiles, ITE scores, and remediation rates. STUDY DESIGN AND METHODS This was a 1-year prospective, multicenter trial involving ten EM residencies from 2017 to 2018. Subjects were PGY-1 to -4 EM residents. Grit-S scores, MCAT percentile, remediation rates, ITE scores, and the ITE score's prediction of passing the ABEM Qualifying Examination were collected. Correlation coefficients were computed to assess the relationship between residents' grit and achievement. RESULTS A total 385 of 434 (88.7%) residents participated who completed the Grit-S as part of a larger study. The mean Grit-S score was 3.62. Grit positively correlated with the predicted likelihood of passing the ABEM Qualifying Examination (r = 0.134, n = 382, p = 0.025). There was no correlation between grit and remediation (r = -0.04, n = 378, p = 0.46) or grit and MCAT percentiles (r =- 0.08, n = 262, p = 0.22). CONCLUSIONS The positive correlation between Grit-S scores and percent likelihood of passing the ABEM Qualifying Examination demonstrates grit's potential to assist residency leadership in early identification of residents who may attain a lower ITE score.
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Affiliation(s)
- Adriana Segura Olson
- Department of MedicineSection of Emergency MedicineUniversity of ChicagoChicagoIL
- Department of Emergency MedicineUniversity of Texas Health San AntonioSan AntonioTX
| | - Kelly Williamson
- Department of Emergency MedicineAdvocate Christ Medical CenterOak LawnIL
| | - Nicholas Hartman
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNC
| | - Navneet Cheema
- Department of MedicineSection of Emergency MedicineUniversity of ChicagoChicagoIL
| | - Nathan Olson
- Department of MedicineSection of Emergency MedicineUniversity of ChicagoChicagoIL
- Department of Emergency/Military MedicineSan Antonio Military Medical CenterFort Sam HoustonTX
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Chou CL, Kalet A, Costa MJ, Cleland J, Winston K. Guidelines: The dos, don'ts and don't knows of remediation in medical education. PERSPECTIVES ON MEDICAL EDUCATION 2019; 8:322-338. [PMID: 31696439 PMCID: PMC6904411 DOI: 10.1007/s40037-019-00544-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Two developing forces have achieved prominence in medical education: the advent of competency-based assessments and a growing commitment to expand access to medicine for a broader range of learners with a wider array of preparation. Remediation is intended to support all learners to achieve sufficient competence. Therefore, it is timely to provide practical guidelines for remediation in medical education that clarify best practices, practices to avoid, and areas requiring further research, in order to guide work with both individual struggling learners and development of training program policies. METHODS Collectively, we generated an initial list of Do's, Don'ts, and Don't Knows for remediation in medical education, which was then iteratively refined through discussions and additional evidence-gathering. The final guidelines were then graded for the strength of the evidence by consensus. RESULTS We present 26 guidelines: two groupings of Do's (systems-level interventions and recommendations for individual learners), along with short lists of Don'ts and Don't Knows, and our interpretation of the strength of current evidence for each guideline. CONCLUSIONS Remediation is a high-stakes, highly complex process involving learners, faculty, systems, and societal factors. Our synthesis resulted in a list of guidelines that summarize the current state of educational theory and empirical evidence that can improve remediation processes at individual and institutional levels. Important unanswered questions remain; ongoing research can further improve remediation practices to ensure the appropriate support for learners, institutions, and society.
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Affiliation(s)
- Calvin L Chou
- Department of Medicine, University of California and Veterans Affairs Healthcare System, San Francisco, CA, USA.
| | - Adina Kalet
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Manuel Joao Costa
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Minho, Portugal
| | - Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kalman Winston
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
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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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Ismailov RM, Khasanova ZD, Gascon P. Knowledge and awareness of biosimilars among oncology patients in Colorado, USA. Future Oncol 2019; 15:2577-2584. [PMID: 31339051 DOI: 10.2217/fon-2019-0194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: We aimed to improve oncology patients' knowledge and awareness of biosimilars. Subsequently, we conducted an assessment of this knowledge by use of an anonymous online survey. Patients & methods: Printed materials discussing major topics related to biosimilars were developed during Phase I of our educational initiative. The brochures contained a link to the online survey. Results: A total of 79 patients responded to our survey. More than 70% of survey participants selected the correct definition of biosimilars and nearly 80% did so on questions focused on regulation, adverse reactions reporting and cost issues related to biosimilars. Conclusion: Our results indicate a good level of both knowledge and awareness of major topics concerning biosimilars among our survey participants.
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Affiliation(s)
- Rovshan M Ismailov
- Complex Mechanisms of Disease, Aging & Trauma (CMDAT) Research Foundation, PO Box 460722 Denver, CO 80246, USA
| | - Zaytuna D Khasanova
- Complex Mechanisms of Disease, Aging & Trauma (CMDAT) Research Foundation, PO Box 460722 Denver, CO 80246, USA
| | - Pere Gascon
- Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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Hopson LR, Dorfsman ML, Branzetti J, Gisondi MA, Hart D, Jordan J, Cranford JA, Williams SR, Regan L. Comparison of the Standardized Video Interview and Interview Assessments of Professionalism and Interpersonal Communication Skills in Emergency Medicine. AEM EDUCATION AND TRAINING 2019; 3:259-268. [PMID: 31360819 PMCID: PMC6637001 DOI: 10.1002/aet2.10346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/16/2019] [Accepted: 03/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The Association of American Medical Colleges Standardized Video Interview (SVI) was recently added as a component of emergency medicine (EM) residency applications to provide additional information about interpersonal communication skills (ICS) and knowledge of professionalism (PROF) behaviors. Our objective was to ascertain the correlation between the SVI and residency interviewer assessments of PROF and ICS. Secondary objectives included examination of 1) inter- and intrainstitutional assessments of ICS and PROF, 2) correlation of SVI scores with rank order list (ROL) positions, and 3) the potential influence of gender on interview day assessments. METHODS We conducted an observational study using prospectively collected data from seven EM residency programs during 2017 and 2018 using a standardized instrument. Correlations between interview day PROF/ICS scores and the SVI were tested. A one-way analysis of variance was used to analyze the association of SVI and ROL position. Gender differences were assessed with independent-groups t-tests. RESULTS A total of 1,264 interview-day encounters from 773 unique applicants resulted in 4,854 interviews conducted by 151 interviewers. Both PROF and ICS demonstrated a small positive correlation with the SVI score (r = 0.16 and r = 0.17, respectively). ROL position was associated with SVI score (p < 0.001), with mean SVI scores for top-, middle-, and bottom-third applicants being 20.9, 20.5, and 19.8, respectively. No group differences with gender were identified on assessments of PROF or ICS. CONCLUSIONS Interview assessments of PROF and ICS have a small, positive correlation with SVI scores. These residency selection tools may be measuring related, but not redundant, applicant characteristics. We did not identify gender differences in interview assessments.
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Affiliation(s)
- Laura R. Hopson
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMI
| | - Michele L. Dorfsman
- Department of Emergency MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Jeremy Branzetti
- Ronald O. Perelman Department of Emergency MedicineNew York University School of MedicineNew YorkNY
| | | | - Danielle Hart
- Department of Emergency MedicineUniversity of Minnesota Medical SchoolSt. PaulMN
| | - Jaime Jordan
- Department of Emergency MedicineDavid Geffen School of Medicine at UCLALos AngelesCA
| | | | - Sarah R. Williams
- Department of Emergency MedicineStanford University School of MedicineStanfordCA
| | - Linda Regan
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMD
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Egan DJ, Gentges J, Regan L, Smith JL, Williamson K, Murano T. An Emergency Medicine Remediation Consult Service: Access to Expert Remediation Advice and Resources. AEM EDUCATION AND TRAINING 2019; 3:193-196. [PMID: 31008432 PMCID: PMC6457352 DOI: 10.1002/aet2.10330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/11/2019] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Abstract
Resident remediation is a complex and common issue in emergency medicine programs and requires a specific knowledge base. The Remediation Task Force (RTF) of the Council of Residency Directors in Emergency Medicine (CORD-EM) was created to identify remediation best practices and to develop tools for program directors. Initially housed on a Wiki page, and now located within the CORD-EM website, the RTF provides resources including accepted universal language for documentation and sample remediation plans. The RTF also created a remediation consult service composed of experienced educators to provide real-time structured feedback and advice to submitted remediation scenarios with consultation outcomes and conclusions uploaded to the website. CORD-EM members now have easy access to online resources and expert advice for remediation queries through the consult service. The combination of online resources and access to real-time expert advice is an innovative approach to improving resident remediation and recognizing best practices.
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Affiliation(s)
- Daniel J. Egan
- Department of Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNY
| | - Joshua Gentges
- Department of Emergency MedicineOklahoma University School of Community MedicineTulsaOK
| | - Linda Regan
- Department of Emergency MedicineJohns Hopkins Medical InstitutionsBaltimoreMD
| | - Jessica L. Smith
- Department of Emergency MedicineAlpert Medical School of Brown UniversityProvidenceRI
| | - Kelly Williamson
- Department of Emergency MedicineUniversity of Illinois at ChicagoAdvocate Christ Medical CenterOak LawnIL
| | - Tiffany Murano
- Department of Emergency MedicineRutgers New Jersey Medical SchoolNewarkNJ
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Biosimilar Knowledge Among Oncology/Hematology Team Members in Colorado, USA: An Educational Initiative and Follow-Up Survey. BioDrugs 2019; 32:499-506. [PMID: 30120705 DOI: 10.1007/s40259-018-0301-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND No data exist regarding oncology/hematology team members' knowledge of and views on biosimilars in Colorado, USA. Published research has suggested that health professionals may have a poor understanding of many issues related to biosimilars. OBJECTIVES Our goal was to increase oncology/hematology team members' knowledge of biosimilars and then use an anonymous online survey to assess the knowledge gained. We also aimed to examine oncology/hematology team members' overall interest in the subject and their motivation to learn more about biosimilars in the future. METHODS In phase I of the project, we developed printed materials covering many topics related to biosimilars, such as definition, regulation, and interchangeability, and the potential of biosimilars in optimal combination therapy for cancer. We distributed our brochures to each participating oncology/hematology office in Colorado. The oncology/hematology team members were then asked to complete the survey. RESULTS A total of 62 team members responded to our survey. Nearly three-quarters of participants were oncology nurses or oncology nurse practitioners. More than 90% of survey respondents identified correct answers about the definition, regulations, interchangeability, safety, cost issues, and use of biosimilars in oncology and in older patients with cancer. Overall, and compared with those who had low levels of interest and motivation, significantly more (p < 0.05) study participants were interested in the subject of biosimilars [57 (92%) vs. 5 (8%)], motivated to learn more about them [59 (95%) vs. 3 (5%)], and interested in sharing information about biosimilars with colleagues and patients [51 (82%) vs. 11 (18%)]. CONCLUSION Our results demonstrate that oncology/hematology team members participating in our study became familiar with many important issues related to biosimilars. Many survey respondents were highly motivated to participate in future training focused on biosimilars, which should pave the way for new educational projects in the area.
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Nadir NA, Hart D, Cassara M, Noelker J, Moadel T, Kulkarni M, Sampson CS, Bentley S, Naik NK, Hernandez J, Krzyzaniak SM, Lai S, Podolej G, Strother C. Simulation-based Remediation in Emergency Medicine Residency Training: A Consensus Study. West J Emerg Med 2019; 20:145-156. [PMID: 30643618 PMCID: PMC6324703 DOI: 10.5811/westjem.2018.10.39781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/19/2018] [Accepted: 10/26/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Resident remediation is a pressing topic in emergency medicine (EM) training programs. Simulation has become a prominent educational tool in EM training and been recommended for identification of learning gaps and resident remediation. Despite the ubiquitous need for formalized remediation, there is a dearth of literature regarding best practices for simulation-based remediation (SBR). METHODS We conducted a literature search on SBR practices using the terms "simulation," "remediation," and "simulation based remediation." We identified relevant themes and used them to develop an open-ended questionnaire that was distributed to EM programs with experience in SBR. Thematic analysis was performed on all subsequent responses and used to develop survey instruments, which were then used in a modified two-round Delphi panel to derive a set of consensus statements on the use of SBR from an aggregate of 41 experts in simulation and remediation in EM. RESULTS Faculty representing 30 programs across North America composed the consensus group with 66% of participants identifying themselves as simulation faculty, 32% as program directors, and 2% as core faculty. The results from our study highlight a strong agreement across many areas of SBR in EM training. SBR is appropriate for a range of deficits, including procedural, medical knowledge application, clinical reasoning/decision-making, communication, teamwork, and crisis resource management. Simulation can be used both diagnostically and therapeutically in remediation, although SBR should be part of a larger remediation plan constructed by the residency leadership team or a faculty expert in remediation, and not the only component. Although summative assessment can have a role in SBR, it needs to be very clearly delineated and transparent to everyone involved. CONCLUSION Simulation may be used for remediation purposes for certain specific kinds of competencies as long as it is carried out in a transparent manner to all those involved.
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Affiliation(s)
- Nur-Ain Nadir
- Kaiser Permanente Central Valley, Department of Emergency Medicine, Modesto, California
- University of Illinois-Peoria, Jump Simulation, Peoria, Illinois
| | - Danielle Hart
- University of Minnesota, Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Michael Cassara
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Department of Emergency Medicine, Manhasset, New York
| | - Joan Noelker
- Washington University in St. Louis, Department of Medicine, Division of Emergency Medicine, St. Louis, Missouri
| | - Tiffany Moadel
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Department of Emergency Medicine, Manhasset, New York
| | - Miriam Kulkarni
- St. John’s Riverside Hospital, Department of Emergency Medicine, Yonkers, New York
| | | | - Suzanne Bentley
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Department of Emergency Medicine and Medical Education, Simulation Center, Elmhurst, New York
| | - Neel K. Naik
- New York Presbyterian, Weill Cornell Medicine, Department of Emergency Medicine, New York, New York
| | - Jessica Hernandez
- University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Sara M. Krzyzaniak
- Kaiser Permanente Central Valley, Department of Emergency Medicine, Modesto, California
- University of Illinois-Peoria, Jump Simulation, Peoria, Illinois
| | - Steven Lai
- Ronald Reagan UCLA Medical Center, Olive View-UCLA Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Gregory Podolej
- Kaiser Permanente Central Valley, Department of Emergency Medicine, Modesto, California
- University of Illinois-Peoria, Jump Simulation, Peoria, Illinois
| | - Christopher Strother
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, Pediatrics, and Medical Education, New York, New York
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Abstract
Early identification and successful remediation of unachieved emergency medicine (EM) milestones are challenging for program directors. Residents who fail to achieve milestones in the expected time frame will have varied educational needs to course correct, dependent on the year of training, as well as the specific deficiencies to resolve. Experts from the Council of Residency Directors in Emergency Medicine (CORD-EM) Remediation Task Force (RTF) collaborated with the objective to create tools for identifying and remediating residents with deficiencies in patient care milestones (PCMs).
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Thaxton RE, Jones WS, Hafferty FW, April CW, April MD. Self vs. Other Focus: Predicting Professionalism Remediation of Emergency Medicine Residents. West J Emerg Med 2018; 19:35-40. [PMID: 29383054 PMCID: PMC5785199 DOI: 10.5811/westjem.2017.11.35242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/09/2017] [Accepted: 11/13/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Unprofessionalism is a major reason for resident dismissal from training. Because of the high stakes involved, residents and educators alike would benefit from information predicting whether they might experience challenges related to this competency. Our objective was to correlate the outcome of professionalism-related remedial actions during residency with the predictor variable of resident response to a standardized interview question: “Why is Medicine important to you?” Methods We conducted a professional development quality improvement (QI) initiative to improve resident education and mentorship by achieving a better understanding of each resident’s reasons for valuing a career in medicine. This initiative entailed an interview administered to each resident beginning emergency medicine training at San Antonio Military Medical Center during 2006–2013. The interviews uniformly began with the standardized question “Why is Medicine important to you?” The residency program director documented a free-text summary of each response to this question, the accuracy of which was confirmed by the resident. We analyzed the text of each resident’s response after a review of the QI data suggested an association between responses and professionalism actions (retrospective cohort design). Two associate investigators blinded to all interview data, remedial actions, and resident identities categorized each text response as either self-focused (e.g., “I enjoy the challenge”) or other-focused (e.g., “I enjoy helping patients”). Additional de-identified data collected included demographics, and expressed personal importance of politics and religion. The primary outcome was a Clinical Competency Committee professionalism remedial action. Results Of 114 physicians starting residency during 2006–2013, 106 (93.0%) completed the interview. There was good inter-rater reliability in associate investigator categorization of resident responses as either self-focused or other-focused (kappa coefficient 0.85). Thirteen of 50 residents (26.0%) expressed self-focus versus three of 54 (5.4%) residents expressed other-focus experienced professionalism remedial actions (p<0.01). This association held in a logistic regression model controlling for measured confounders (p=0.02). Conclusion Self-focused responses to the question “Why is Medicine important to you?” correlated with professionalism remedial actions during residency.
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Affiliation(s)
- Robert E Thaxton
- San Antonio Uniformed Services Health Education Consortium, Department of Emergency Medicine, San Antonio, Texas
| | - Woodson S Jones
- San Antonio Uniformed Services Health Education Consortium, Department of Graduate Medical Education, San Antonio, Texas
| | - Fred W Hafferty
- University of Minnesota Medical School, Department of Behavioral Sciences, Minneapolis, Minnesota
| | - Carolyn W April
- University of Texas Health Sciences Center San Antonio, Department of Medicine, San Antonio Texas
| | - Michael D April
- San Antonio Uniformed Services Health Education Consortium, Department of Emergency Medicine, San Antonio, Texas
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Heitz CR, Coates W, Farrell SE, Fisher J, Juve AM, Yarris LM. Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2015. Acad Emerg Med 2017; 24:1212-1225. [PMID: 28857348 DOI: 10.1111/acem.13305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objectives were to critically appraise the medical education research literature of 2015 and review the highest-quality quantitative and qualitative examples. METHODS A total of 434 emergency medicine (EM)-related articles were discovered upon a search of ERIC, PsychINFO, PubMED, and SCOPUS. These were both quantitative and qualitative in nature. All were screened by two of the authors using previously published exclusion criteria, and the remaining were appraised by all authors using a previously published scoring system. The highest scoring articles were then reviewed. RESULTS Sixty-one manuscripts were scored, and 10 quantitative and two qualitative papers were the highest scoring and are reviewed and summarized in this article. CONCLUSIONS This installment in this critical appraisal series reviews 12 of the highest-quality EM-related medical education research manuscripts published in 2015.
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Affiliation(s)
- Corey R. Heitz
- Carilion Clinic/Virginia Tech Carilion School of Medicine; Roanoke VA
| | - Wendy Coates
- Harbor/University of California Los Angeles Medical Center; Los Angeles CA
| | | | - Jonathan Fisher
- Maricopa Medical Center/University of Arizona College of Medicine-Phoenix; Phoenix AZ
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Heitz CR, Coates W, Farrell SE, Fisher J, Juve AM, Yarris LM. Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2015. AEM EDUCATION AND TRAINING 2017; 1:255-268. [PMID: 30051043 PMCID: PMC6001510 DOI: 10.1002/aet2.10063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The objectives were to critically appraise the medical education research literature of 2015 and review the highest-quality quantitative and qualitative examples. METHODS A total of 434 emergency medicine (EM)-related articles were discovered upon a search of ERIC, PsychINFO, PubMED, and SCOPUS. These were both quantitative and qualitative in nature. All were screened by two of the authors using previously published exclusion criteria, and the remaining were appraised by all authors using a previously published scoring system. The highest scoring articles were then reviewed. RESULTS Sixty-one manuscripts were scored, and 10 quantitative and two qualitative papers were the highest scoring and are reviewed and summarized in this article. CONCLUSIONS This installment in this critical appraisal series reviews 12 of the highest-quality EM-related medical education research manuscripts published in 2015.
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Affiliation(s)
- Corey R. Heitz
- Carilion Clinic/Virginia Tech Carilion School of MedicineRoanokeVA
| | - Wendy Coates
- Harbor/University of California Los Angeles Medical CenterLos AngelesCA
| | | | - Jonathan Fisher
- Maricopa Medical Center/University of Arizona College of Medicine–PhoenixPhoenixAZ
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Smith JL, Lypson M, Silverberg M, Weizberg M, Murano T, Lukela M, Santen SA. Defining Uniform Processes for Remediation, Probation and Termination in Residency Training. West J Emerg Med 2016; 18:110-113. [PMID: 28116019 PMCID: PMC5226740 DOI: 10.5811/westjem.2016.10.31483] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/03/2016] [Accepted: 10/26/2016] [Indexed: 11/11/2022] Open
Abstract
It is important that residency programs identify trainees who progress appropriately, as well as identify residents who fail to achieve educational milestones as expected so they may be remediated. The process of remediation varies greatly across training programs, due in part to the lack of standardized definitions for good standing, remediation, probation, and termination. The purpose of this educational advancement is to propose a clear remediation framework including definitions, management processes, documentation expectations and appropriate notifications. Informal remediation is initiated when a resident's performance is deficient in one or more of the outcomes-based milestones established by the Accreditation Council for Graduate Medical Education, but not significant enough to trigger formal remediation. Formal remediation occurs when deficiencies are significant enough to warrant formal documentation because informal remediation failed or because issues are substantial. The process includes documentation in the resident's file and notification of the graduate medical education office; however, the documentation is not disclosed if the resident successfully remediates. Probation is initiated when a resident is unsuccessful in meeting the terms of formal remediation or if initial problems are significant enough to warrant immediate probation. The process is similar to formal remediation but also includes documentation extending to the final verification of training and employment letters. Termination involves other stakeholders and occurs when a resident is unsuccessful in meeting the terms of probation or if initial problems are significant enough to warrant immediate termination.
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Affiliation(s)
- Jessica L Smith
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - Monica Lypson
- University of Michigan, Department of Internal Medicine, Ann Arbor, Michigan
| | - Mark Silverberg
- SUNY Downstate/Kings County Hospital, Department of Emergency Medicine, Brooklyn, New York
| | - Moshe Weizberg
- Staten Island University Hospital, Northwell Health, Staten Island, New York
| | - Tiffany Murano
- Columbia University Medical College-NY Presbyterian Hospital, Department of Emergency Medicine, New York, New York
| | - Michael Lukela
- University of Michigan, Department of Internal Medicine, Ann Arbor, Michigan; University of Michigan, Department of Pediatrics, Ann Arbor, Michigan
| | - Sally A Santen
- University of Michigan, Department of Learning Health Sciences, Ann Arbor, Michigan
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