Accreditation Council for Graduate Medical Education (ACGME) - Public Search. However, the majority of performance concerns that program directors and CCCs will have to address will be related to deficiencies in medical knowledge, technical expertise, or professionalism. Kinne Medical or mental health issues that affect resident performance are also grounds for remediation, probation, or dismissal. Other specialty groups outside pathology have offered their approaches to resident remediation and the approach outlined here incorporates these various principles.13–18 Before a remediation plan can be developed, every effort needs to be made to ensure that the correct underlying problem, deficiency, or performance issue is identified. Is Adding IgM Antibody to Polymerase Chain Reaction Testing Useful for COVID-19 Travel Screening? The ACGME is incharge of accrediting U.S. medical and surgical residencies. In addition, it is typically the program director who signs the various forms verifying competence and fulfillment of accredited training to allow the graduating resident or fellow to sit for his or her board examination, to obtain state licensure, and to obtain hospital credentialing and privileges. Available at: http://www.mbc.ca.gov. Incident reports or hallway “spur of the moment” conversations with the program director may trigger a concern that warrants further investigation. Residency training ensures physicians develop the knowledge, skills, and attitudes required to practice medicine independently, and provides the foundation for professional growth.1 Recently, the Accreditation Council on Graduate Medical Education (ACGME) and the American Board of Medical Specialties created the Milestones Project to provide competency-based outcomes for trainees. Delay of a Site Visit - The ACGME conducts a large number of site visits annually and expects programs to accommodate the visit on the assigned date. . For example, one state licensing board asks this question of both the applicant and of the program director: “Has any academic program, health care entity or professional organization ever taken against you [the resident], through either oral or written communication, any of the following public or private actions: warning, censure, reprimand, or formal admonishment; limitation, reduction, suspension, revocation or denial of privileges; additional limitations or requirements placed on you based on your clinical performance, academic performance, discipline, or foranyother reason; placement on academic or disciplinary probation; acceptance of voluntary resignation in lieu of further investigations or other action; are any such actions listed [above] pending; are you currently under investigation by any academic program, health care entity or professional organization?”11 Another state medical board asks the resident and program director: “Was the applicant ever placed on probation… disciplined or placed under investigation; were any incident reports regarding this applicant ever filed by instructors; were any limitations or special requirements placed upon the applicant for clinical performance, professionalism, medical knowledge, discipline, or for any other reason; was the applicant ever terminated, dismissed or expelled?”12 Broad statements like these have the potential of being broadly interpreted by the resident or the program director so it is important for all concerned to be clear about the level of concern or severity of the performance issue when it is discussed with the resident. . The ACGME ruling comes a little over a year after a medical resident in the cardiovascular program alleged that a cardiologist sexually assaulted her and other fellows. Accessed December 18, 2013. Most programs—typically at the quarterly or semiannual formal evaluation—will provide needed feedback to the resident on areas that he or she could improve on going forward. 6 residents received “pre-probation” 8 residents –progress committees 1 resident –non-promotion (4 months) 3 residents terminated 2 residents resigned/transferred. For example, a program director and I met with a resident concerning a professionalism incident. Any terms of probation shall be related to the reason for the probation and shall be set for a specific period of time. February 24-26, 2021 The ACGME’s Resident Services division does not adjudicate disputes between individual persons and residency/fellowship programs or sponsoring institutions. . Schwind The hospital had 319 beds; the program takes 4 residents a year. Hickson No further performance issues occurred and the resident graduated in good standing and moved to another state for fellowship training. However, the Accreditation Council for Graduate Medical Education and the EM PDs have not defined these terms, and individual institutions must set guidelines defining a change in resident status from good standing to remediation or probation. NL The 220-bed teaching hospital in Providence, R.I. has been operating its residency programs under “probationary accreditation” since July 8, according to documents posted on the website of the Accreditation Council for Graduate Medical Education … It is important to document how the resident failed to resolve the identified deficiencies during remediation and probation. Available at: http://www.tmb.state.tx.us. According to the ACGME, they had been approved for 24 slots; 17 of which were filled. Wu I did residency at a small family medicine program. As noted before, not all subpar performance issues rise to the level of remediation or probation. Copyright © 2021 American Society for Clinical Pathology. Despite everyone’s best efforts, remediation and probation plans are not always successful and the difficult decision to terminate a resident must be made.20 Not all behaviors or deficits can be remediated, and as noted before, some residents may simply find themselves in a field of medicine in which it is beyond their ability to meet the milestones. List of programs under ACGME probation used. Learn and connect online at the 2021 Annual Educational Conference. It is important to document how the resident failed to resolve the identified deficiencies during remediation and probation. C Program directors should also familiarize themselves with any institutional policies about informing the graduate medical education committee or the institution’s legal counsel whenever a resident or fellow is placed on remediation or probation or is dismissed. Figure 1 outlines an algorithmic approach to dealing with most performance issues. Termination occurs when a resident fails to meet the terms of probation or if initial problems are significant enough to warrant immediate termination. A resident may be put on probation prior to initiation of or exhaustion of the hearing process. Timely and truthful evaluation and feedback of resident performance is critical to identifying problems early and at a stage where they can, hopefully, be corrected. Hawaii Residency Programs, Inc. (HRP) is an independent, not-for profit corporation that 1) supports the advancement of medical education and training for medical residents in Hawaii, 2) coordinates the administration of the residency programs and 3) acts as a liaison between the residency programs and the affiliated hospitals/healthcare systems. LEARN MORE, Meaning in Medicine: Mastering the Moment. Fifty six programs were listed, they were sorted based on state and then on speciality. Sanfey Announcements will be made in the ACGME’s weekly e-Communication when revised FAQ documents are available. The poorly performing resident requires extra time and resources from the faculty and the program and can be disruptive for the entire program. The ACGME does not disclose reasons for probation, but the News reported that duty hour violations occurred at both programs. The major details of the plan should be put in writing, signed by the resident and the program director, and placed in the resident’s file. RG Probation may include relieving a resident of clinical responsibilities. With the recent requirement by the Accreditation Council for Graduate Medical Education (ACGME) for every accredited training program to have a Clinical Competence Committee (CCC), the burden of responsibility for verifying the competence of residents and fellows will now be shared between the program director and the CCC. The ACGME added to its resources for the GME community related to personal protective equipment (PPE). Learn and connect online at the 2021 Annual Educational Conference. Sadosty Dudek Access these resources in Learn at ACGME. Probation. Roberts The ACGME, which accredits graduate medical training programs including residencies, will send representatives to the school Jan. 16 to talk to residents, according to a report in the St. Medical Board of California The ACGME Common Program Requirements are a basic set of standards (requirements) in training and preparing resident and fellow physicians. [Primary small cell neuroendocrine carcinoma of the larynx: a review of literature and case series]. . Ratan Throughout the remediation process it is important for the discussion to openly include potential options if the remediation/probation plan fails. After successful treatment in a rehabilitation facility (for example), the program could request/require “fit for duty” documentation that the resident has successfully completed the course of treatment and is able to return to duties. There are three decisions that can be made: Accreditation, probationary accreditation, or withdrawl of accreditation. Depending on the performance issues being addressed in the remediation or probation plan, the resident could be dismissed immediately, at some future time during the contract year, or at the end of the current contract year (ie, nonrenewal of contract). Residents achieve ACGME milestones at different stages during training. Cohen Dahms Although ACGME posts the decisions, it withholds crucial information about the reason for these decisions. Because most programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME), they are required by ACGME guidelines to provide a minimum amount of due process to residents and fellows when they are subject to disciplinary action. Many state licensing boards and hospital credentialing entities are increasingly crafting language to ferret out every possible performance issue in a person’s training, no matter how insignificant (they are no longer simply asking if the applicant has been on probation or dismissed). According to the suit, McDaniel was punished for using new ACGME coding rules for medical procedures, and was denied time off after undergoing retina surgery. . RB Webb Residents whose performance meets the expected standards will be promoted to the next level of training. . or. This is a normal part of the evaluation and feedback process (eg, some program directors make it a point to always give each resident one area in which he or she can improve—ie, the “no one is perfect and all of us can find room for improvement” approach). During the 2017-18 academic year, the ACGME had only one institution on probation out of the 830 accredited in the U.S. SN The program director and/or the resident’s mentor will need to make fine distinctions based on defined and written expectations for all trainees. The ACGME has no specific definition for resident remediation and references it in regard to the Clinical Competency Committee (CCC) “recommending concerns to the Program Director regarding resident performance (which may result in remediation, probation, termination)” 19. Solnik Accreditation Council for Graduate Medical Education. Suite 2000 401 North Michigan Avenue Chicago, Illinois 60611; Telephone: 312.755.5000 Facsimile: 312.755.7498 Resident Services does not address issues regarding matters of admission, appointment, contract, credit, discrimination, promotion, or dismissal of faculty members, residents or fellows. Berkowitz Behrns, who joined the medical school in January 2017, about a month before that probation, said since that occurred and since the 2017 resident survey by the ACGME… et al. Stability of phosphatidylethanol 16:0/18:1 in authentic and spiked whole blood. A resident cannot be forced to seek counseling or therapy, and the program director should not attempt to diagnose the perceived medical or mental issue for the resident or insist that a resident seek specific therapy. Although the process leading up to the dismissal of an underperforming resident is time consuming and disruptive, failure to do so can have long-range negative ramifications for future patients and coworkers.2,20 It is imperative that programs plan ahead on how to deal with underachieving residents and fellows and give the faculty and staff the appropriate tools to help them make honest performance assessments.3,20, The suggested guidelines or principles presented here should provide a basic framework for training program personnel to assess and establish their own approaches to the poorly performing resident. It is recommended that in addition to the program director at least one other faculty member (eg, a CCC member, the department chair, the resident’s faculty mentor, the institution’s associate dean for graduate medical education, etc) should be present when the remediation or probation plan is presented and discussed with the resident. However, the program can expect that a resident take any necessary steps to address medical or mental health issues and to produce a “fit for duty” letter/evaluation from the appropriate health care provider as part of a remediation plan before he or she will be allowed to continue. Pichert Objectives. Special resident rate $45! 3 Some residents require remediation (additional training, assistance or supervision) to meet expectations. Please contact a member of the Review Committee staff if you have a question about a program requirement. . The general surgery program lacked adequate faculty performing research and the pediatric surgery program had a shortage of cases for resident training, according to The News . Further reporting might indicate what led to probation—poor training environments, violation of resident work hours, inadequate supervision, educational deficiencies, or something else entirely. Remediation, probation, or dismissal of the poorly performing pathology resident is one of the most difficult and challenging aspects of any pathology training program. PM For example, a general surgery resident may be fulfilling all of the core competencies and milestones except those related to the technical aspects of performing surgery and may benefit from career counseling to consider another specialty of medicine. For example, a resident who is normally prepared for an unknown surgical case conference but who falls short on one or two occasions may not warrant more than a verbal inquiry as to why he or she was not prepared. A… The ACGME compiles an up-to-date list of residency programs under probation or with withdrawn accreditation in all specialties. In applying for a state license, the resident indicated a “no” response to the question related to a written warning or admonishment while the program director answered “yes.” As might be expected, the confusion caused a delay in the graduate obtaining state licensure and in starting fellowship training. Suggested approach to handling resident performance problems. et al. Emergency medicine (EM) residency program directors (PDs) nationwide place residents on remediation and probation. Baltimore Office 120 East Baltimore Street, Suite 1700 Baltimore, MD 21202 (410) 962-1030 ; Washington, D.C. Office 1717 K Street, NW, Suite 900 Washington, DC 20006 (202) 742-5969 The ACGME compiles an up-to-date list of residency programs under probation or with withdrawn accreditation in all specialties. Thus, both the program director and the resident need to be clear as to the meaning of the particular intervention and any future ramifications related to probation, a remediation plan, an adverse incident report, or any written or verbal warnings or admonishments. Residents Medical’s curriculum assessment will identify areas of violation and non-compliance to then address, adapt, and implement in order to improve the performance of your program. This transformative process of incompetence to competence also requires that faculty be given the tools and education to function in the roles of mentor, evaluator, and effective teacher. Williams Tulgan JW G This article describes one individual’s suggested approach to handling performance issues in residents and fellows and is based on many years of experience and involvement with numerous cases in pathology as well as in residency training programs outside pathology. In addition, the institution’s graduate medical education office and designated institutional official should not be surprised at the last minute but should have been kept informed, at least informally, in the event that legal counsel needs to be involved or other issues need to be addressed.21,22 In addition, as part of the dismissal meeting, it should be made clear to the resident what rotations and/or number of months of credit (if any) he or she will be given for the time spent in the program. Breast Tumor Microenvironment in Black Women: A Distinct Signature of CD8+ T Cell Exhaustion. Resident/Fellow Remediation Policy and Grievance Procedure . The GME office, legal counsel and human resources are often involved in R Thus, caution is warranted to not use the terms “remediation” or “probation” lightly unless you truly mean it as such with defined goals, a defined timeline, and defined consequences if the goals and timeline are not met. Probation is a conditional status that places specified requirements for improved performance on the resident, with dismissal from the residency as a possible result if the prescribed improvement does not occur. Accessed December 18, 2013. Surveys are designed to assess … St. Louis University’s (SLU) medical school is expecting a visit later this month by the ACGME to talk with residents about concerns regarding the learning environment and growing resident fear of retaliation. Unprofessional behavior has been identified as probably the single most common cause for disciplinary action against medical students, residents, and fellows.6–9 In pathology, one study found that professionalism issues such as honesty, reporting/recognizing medical errors, collegial and interpersonal interactions, and conflict of interest were recognized as important ethical and professionalism issues in our profession.10 Other professionalism issues that might warrant remediation include attitudinal problems (laziness, mood swings, rudeness to coworkers or peers, no-show for important/expected conferences, excessive/inappropriate cell phone usage during duty hours, etc); excessive staff or patient complaints; interpersonal conflicts (abusive behavior toward others, confrontational style with support staff, peers, or faculty, etc); or other inappropriate behaviors toward staff, peers, or faculty.6–9. Ultimately, faculty development in assessing the core competencies and milestones in their trainees is a key component to ensure that residents are given the support and encouragement they need to best effect their success and competence upon graduation.3 Faculty development also helps to ensure that resident performance and professionalism issues are identified early and dealt with appropriately.3 However, a review of the extensive literature on this topic is beyond the scope of this article. Resident probation – The GME Director can provide the program with useful guidance and outline the process that needs to be followed prior to putting a resident on probation. The purpose of this policy and process is to establish disciplinary procedures for all Graduate Medical Education (GME) training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) to follow if a Resident’s training in such a program fails to meet academic expectations and/or engages in misconduct. et al. Register now! However, the program director’s attestation and signature typically will remain the final and official verification on a graduate’s paperwork.1 Through the use of the CCC, it is hoped that resident performance issues will be identified and addressed in a timely fashion, and that the unpleasantness of remediation, probation, or dismissal from the program, for any resident, will be a committee decision rather than the sole responsibility of the program director. Residency programs must be accredited by the ACGME in order to receive funding from the Center for Medicare and Medicaid services. Documentation, ongoing assessment of performance, a defined timeline, and defined next steps are critical components to any remediation or probation plan. How the program director will respond to requests from outside agencies concerning the resident’s performance in the program should also be made clear. Despite best efforts, not all remediation plans are successful and dismissal of the resident will need to be seriously considered. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Thank you to all who are contributing to patient care and medical education. Milestones serve many purposes in both graduate medical education and the accreditation process. H B Resident probation – The GME Director can provide the program with useful guidance and outline the process that needs to be followed prior to putting a resident on probation. Alexander For example, if a resident has severe depression that affects his or her ability to perform as expected, then the program can require a “fit for duty” evaluation from a physician or other appropriate health care provider that states the resident is now (currently) able to effectively perform his or her duties (it would be the responsibility of the resident to initiate, maintain, and follow through on any necessary therapy, but if the resident asks for help or advice, then the program director is free to assist him or her). After the meeting, documentation was placed in the resident’s file detailing the incident, the meeting, and the consequences if the behavior recurred. LE It is no longer appropriate for training programs to foster a “sink or swim” attitude toward residency training and to knowingly graduate poorly performing residents who have not fulfilled the core competencies or met the milestones.2,20 As Steinberg2 notes, “we must all walk down this path together.”. DaRosa Documentation is very important throughout the entire remediation/probation period and will minimize or neutralize any potential legal questions in the future.21,22 If the emotional stability of the resident is in doubt, it may be appropriate to station security personnel close by during the meeting. According to that article, the 159 bed hospital took 18 residents in a span of 2 years. Ogunyemi Register now! 3 Definition: Probation 5 JS During the 2017-18 academic year, the ACGME had only one institution on probation out of the 830 accredited in the U.S. If the resident is given additional paid time following a failed remediation plan, his or her clinical or patient care duties may need to be adjusted, limited, or curtailed until the departure date. The program director may perform such verification procedures multiple times over years or decades for individual graduates. A 360-degree evaluation that comes from a laboratory technologist or an apheresis nurse, for example, may raise concerns about a resident’s interactions with allied health staff or patients. Your program may receive citations from the ACGME if these qualities are not met. The ACGME is separate from the Liaison Committee on Medical Education (LCME), which put SLU’s medical school accreditation on probation last year. Remediation and its more serious and ominous counterpart, probation, is a process with defined goals, timeline, and consequences if the goals and timeline are not met Table 1.13,14 Remediation is often the first step before probation, which is usually followed by termination if the resident fails to improve. Although it is a decision that may not come as a total surprise to the involved resident, some residents will be in a state of denial. Marks Perhaps a better term in situations where remediation or probation is not warranted, but where improvement could be made, might be “on-going self-improvement,” “area(s) for educational improvement,” “area(s) for self-enhancement of the core competencies,” “performance improvement or enhancement discussion (or evaluation),” “informal intervention” (ie, a “cup of coffee conversation”), “effective milestone achievement,” or “continuous competency improvement.” Terms like “remediation” and “probation” are frequently used by credentialing agencies but can sometimes have different meanings for different groups. Accreditation Council for Graduate Medical Education (ACGME) Institutional Requirements and must ensure that its ACGME-accredited programs are in substantial compliance with the Institutional Requirements, Common Program Requirements, and … CJ The institution’s grievance and due process or appeal policy should also be presented to the resident during the dismissal meeting. Scope: All residents and fellows in training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME), or Council on Dental Accreditation (CODA), or approved by the American Board of Medical Specialties (ABMS), and sponsored by the UW School of Medicine. Whatever the situation, dismissal is a decision that should not be made lightly and without general agreement between the program director and a majority of the CCC. The remediation plan should only target and address the specific issue(s) identified, should have clearly defined goals with defined measures/assessments, a clearly defined and realistic timeline for achieving the goals, designated faculty or mentors (if necessary) to assist the resident, defined points along the timeline for the resident and program director to meet and assess progress to date, and clearly delineated consequences or next steps if the resident fails the remediation plan (Table 1). As a former designated institutional official, I always appreciated being informed earlier rather than later about at-risk residents who are placed on remediation or probation. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. et al. To adequately assess and evaluate a resident’s performance, close observation by multiple observers using multiple evaluation tools is required at multiple points during the training period. These requirements set the context within clinical learning environments for development of the skills, knowledge, and attitudes necessary to take personal responsibility for the individual care of patients. The GME office will also receive correspondence from licensing and credentialing organizations looking for probation-related information on a resident. The ACGME is incharge of accrediting U.S. medical and surgical residencies. Oxford University Press is a department of the University of Oxford. Accreditation Council for Graduate Medical Education (ACGME) - Public Programs or Institutions with Probationary Status Programs or Institutions with a Probationary Status (based on … That is ridiculous. . The ACGME Common Program Requirements are a basic set of standards (requirements) in training and preparing resident and fellow physicians. When a resident leaves a program where he or she was put on probation for some length of time, it is common to receive a request to remove that status from his or her file. Most of us can find areas for improvement, but it does not necessarily rise to the level of remediation. Boiselle Likewise, if a resident had a medical issue that has or could affect performance (eg, poorly controlled type 1 diabetes that results in periodic cognitive impairment), a “fit for duty” letter from the treating physician indicating that the resident’s blood glucose is now well controlled may be required/requested before the resident can return to the program. . 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