Colorectal Surgery Resident Manual

ACADEMIC DEFICIENCIES AND CORRECTIVE ACTION

Each program director is responsible for assessing and monitoring a resident’s academic and professional progress in the areas of:

• Medical Knowledge
• Clinical Competence in Patient Care
• Interpersonal and Communication Skills
• Professionalism (includes absence of impairment)
• Attitudes
• Practice-Based Learning and Improvement
• Systems-Based Practice
• Adherence to departmental, institutional and hospital policies and procedures

Failure to perform adequately in any of these areas may result in corrective action up to and including termination.  If a resident is not progressing adequately, the program has a responsibility to inform the resident of the deficiency and provide him/her an opportunity to correct the deficiency.  At times it is possible and appropriate for the program to provide extra assistance or educational experiences for the resident to aid in this.  It is ultimately the residents’ responsibility to take the steps necessary to meet expectations.

All residency/fellowship programs shall be subject to the following corrective action procedures for academic deficiencies.  The program director is responsible for selecting the most appropriate action among those listed below, based on the severity of the problem, and communicating this to the resident.     Decisions to place a resident on probation or to suspend or terminate a resident will be made in consultation with the DIO/Chair of the GMEC, with written documentation of same.

The following steps occur at the program level. They do not need DIO input. 

VERBAL WARNING may be imposed for deficiencies for which some degree of correction is necessary.  The deficiency will be clearly outlined for the resident, who will have a reasonable opportunity, within a specified timeframe, to correct the deficiency.  Any educational interventions shall be specified and monitored with the resident receiving feedback in followup meetings with the program director.  The program director will place a written note in the resident’s file specifying the deficiency and the outcome of the intervention.  If the deficiency is corrected, this will be noted and no further action will be taken.  If the deficiency is not corrected, this will be noted, and the resident may receive a letter of concern, written warning or may be placed on probation, suspended, or terminated.

LETTER OF CONCERN may be given for deficiencies that warrant more serious measure than a verbal warning.  As with a verbal warning, the deficiency should be outlined and monitored. The resident will have a reasonable opportunity to correct the deficiency and any educational interventions specified and monitored.  If the deficiency is corrected, this will be noted and no further action need be taken.  If the deficiency is not corrected, this will be noted, and the resident may receive a written warning or may be placed on probation, suspended or terminated.

The following corrective action procedures are for more serious deficiencies.  One of the following options should be utilized in any situation where a resident is or may be required to extend their training or if there is any significant possibility that they may be unable to continue in the program.  Any of these steps require the review and co-signature of the DIO/Chair of the GMEC.

WRITTEN WARNING may be imposed for more serious deficiencies than described in a VERBAL WARNING or a LETTER OF CONCERN.  A written warning should always include the following items:

1. The required standard
2. The observed deficiency
3. The required remediation
4. A timeline for achieving remediation
5. What will be done to assist the resident in meeting expectations
6. Mechanism of evaluation used to determine improvement
7. Consequences of achieving the remediation
8. Consequences of not achieving the remediation

PROBATION may be imposed for substantial, continuing, or multiple deficiencies.

Using the attached template, the conditions of the written warning or probation shall be specified by the program director in writing (including items a-h), signed by the program director and the DIO/Chair of the GMEC, and delivered to the resident. The program director shall discuss the conditions of any remediation with the resident and require the resident to sign the conditions to acknowledge their receipt and the resident’s commitment to achieve remediation.

SUSPENSION may be imposed for more serious deficiencies than described in the previous three paragraphs, including, but not limited to, those which may involve the safety of patients, the resident, or others. The conditions of suspension shall be specified by the program director in writing (including items a-h), signed by the program director and the DIO/Chair of the GMEC, and delivered to the resident. The program director shall discuss the conditions of suspension with the resident and require the resident to sign the conditions to acknowledge their receipt and the resident’s commitment to achieve remediation. During suspension the resident will be removed from his/her clinical rotations and will not receive credit for training. Upon completion of suspension, the resident may be placed on probation.

TERMINATION may be imposed for academic reasons, professionalism reasons, or if the resident is deemed to threaten the safety of patients, the resident, or others.  Notice of termination in writing signed by the program director and the DIO/Chair of the GMEC shall be delivered to the resident.

A resident may challenge any actions hereunder in accordance with the Grievance Procedure for Residents.  Any resident given a written warning, placed on probation, suspended, or terminated shall be given a copy of the Grievance Policy.

Approved by GMEC October 19, 2001
Amended and approved by the GMEC June 20, 2003
Amended and approved by the GMEC on August 3, 2007

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