How a Teaching Hospital Implemented Its Termination Policies for Disruptive Residents

Abstract

The development of Policy Standards for Termination that both protect and support residents while safeguarding sponsoring institutions has become increasingly necessary. To date, however, there has been little in the literature that discusses policies that have undergone thorough testing to the highest levels of the U.S. judicial system. Berkshire Medical Center (BMC), an acute-care community teaching hospital affiliated with the University of Massachusetts Medical School, developed a set of specific policies to cope fairly with the resident dismissal process. The authors describe a nine-year legal test of these policies in the case of a resident whose disruptive behavior required their implementation. Also presented is a summary of due process as it applies in such cases. The dismissed resident tested the policies through the Courts of the Commonwealth of Massachusetts all the way to the United States Supreme Court, the Equal Employment Opportunity Commission, and the Massachusetts Department of Industrial Accidents. At every level the termination action was upheld. The resident had previously been in two graduate medical education programs at other institutions, and neither of them had communicated issues of concern that would have forewarned BMC's program about potential problems. A plea for honest and open communication between programs is made. This may help to avoid the lengthy, expensive, and potentially serious consequences of such situations. However, the authors emphasize that when such situations arise, strong policies serve as an ultimate legal protection.

Justice and care: decision making by medical school student promotions committees

“…The 'failure to fail' literature, a body of work exploring the perceived barriers to accurately grading learners who do not meet academic benchmarks, makes it clear that there are contextual, personal and student-centred variables that play a role in faculty members' decision making about students. [12][13][14][15][16][17][18][19][20] For example, Luhanga et al found that preceptors considered learners' debt and proximity to graduation when deciding whether or not to submit a failing grade. 16 One goal of this study was to explore which particular student-centred elements most inform and influence committee members' decision making.…”

“…The mean student debt for that same year was $180 723. Given these circumstances, dismissal from medical school can have an enormous emotional, financial and professional impact on the lives of medical students …”

“…[6][7][8][9][10][11][12] There is well-documented evidence that faculty members in the health professions experience barriers to accurate evaluation of underperforming learners, and that these barriers influence faculty members' decisions about the submission of failing grades. [12][13][14][15][16][17][18][19][20] However, no study to date has extended the issue of underperforming medical students to the administrative processes triggered when failing grades are submitted. The seriousness of the issue is magnified by evidence that student behaviours related to dropout or dismissal, which include academic struggles and dishonest or unprofessional behaviour, are consistent over time.…”

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

“…[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.…”

Letters to the Editor

“…Thorough documentation of all issues related to problem residents is also critical. 4 JGIM welcomes your letters and comments. Letters may contain brief commentaries on articles published in the Journal, illustrative case reports, general suggestions for improving the Journal, or other information of interest to readers.…”