Guiding Principles for Resident Remediation: Recommendations of the CORD Remediation Task Force

Abstract

Remediation of residents is a common problem and requires organized, goal-directed efforts to solve. The Council of Emergency Medicine Residency Directors (CORD) has created a task force to identify best practices for remediation and to develop guidelines for resident remediation. Faculty members of CORD volunteered to participate in periodic meetings, organized discussions and literature reviews to develop overall guidelines for resident remediation and in a collaborative authorship of this article identifying best practices for remediation. The task force recommends that residency programs:1. Make efforts to understand the challenges of remediation, and recognize that the goal is successful correction of deficits, but that some deficits are not remediable. 2. Make efforts aimed at early identification of residents requiring remediation. 3. Create objective, achievable goals for remediation and maintain strict adherence to the terms of those plans, including planning for resolution when setting goals for remediation. 4. Involve the institution's Graduate Medical Education Committee (GMEC) early in remediation to assist with planning, obtaining resources, and documentation. 5. Involve appropriate faculty and educate those faculty into the role and terms of the specific remediation plan. 6. Ensure appropriate documentation of all stages of remediation. Resident remediation is frequently necessary and specific steps may be taken to justify, document, facilitate, and objectify the remediation process. Best practices for each step are identified and reported by the task force.ACADEMIC EMERGENCY MEDICINE 2010; 17:S95-S103 ª

Resident Remediation, Probation, and Dismissal Basic Considerations for Program Directors

“…Poor performance can have confounding or contributing factors such as stress at home, substance abuse, cognitive issues related to language or processing issues, etc. 13 As noted later, the program director or CCC should not try to diagnose confounding problems but can help point the resident to resources to help him or her identify and treat any contributing factors. 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).…”

“…13,14 Remediation is often the first step before probation, which is usually followed by termination if the resident fails to improve. However, depending on the severity of the issue(s), a failed remediation could also end in dismissal or nonrenewal of contract if the resident fails to achieve the defined goals, and probation may be the first step rather than remediation.…”

“…[13][14][15][16][17][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. Poor performance can have confounding or contributing factors such as stress at home, substance abuse, cognitive issues related to language or processing issues, etc.…”

« Ils sont carrément incurables » : comment les métaphores des cliniciens enseignants révèlent leur malaise dans la gestion des difficultés de raisonnement clinique de leurs internes

“…La littérature s'accorde à reconnaitre l'importance de mettre en oeuvre des processus de remédiations de telles difficultés [6][7][8][9] . On souligne notamment l'importance d'identifier les difficultés rapidement, de poser un diagnostic pédago-gique de ces difficultés, d'en identifier la source ou les causes, enfin de mettre en oeuvre un plan de remé-diation et de suivi, à la fois personnalisé et spécifique, des difficultés identifiées [8][9][10][11][12] .…”

R & P: The Medical Education Scarlet Letters

“…The comprehensive reference list provided by Weizberg et al sits at just nine articles. A key reference is the excellent work by Katz et al, 2 which provides standardized definitions and a suggested guideline for the process.…”