April Armstrong, BSc(PT), MD, MSc, FRCSC

Associate ProfessorChief Shoulder and Elbow Service

Dept. of Orthopaedic Surgery and RehabilitationPenn State Milton S. Hershey Medical Center

Hershey, PA

Developing a Remediation Plan for Underperforming Residents

PREVENTION

Disclosure

• Consultant for Zimmer, Inc.– Not related to this presentation

Resident Selection• “Don’t let them in your program”• Don’t be blinded by scores or transcripts• Take those you know are good

– AI’s, Home students• Emphasize the affective

– Generate “discriminating” questions

• Remember that you are matching the candidate to your program- know your program

Resident Selection

• Be wary of those who circumvent your regular selection process– Transfers– “legacies”

• Follow up on recommendations if any question

Know your “Due Process”• Know this in ADVANCE!• Consult institutional legal and administrative experts• different for each state and institution

– all require documentation and evidence of attempts at remediation

• All resident evaluation can be part of Due Process– process built upon documentation, regular evaluation, and resident

advocacy

• work is already initiated before any problem is seen and will be detected earlier

Program Planning“Be the Maestro”

• “Resident centric”– Shared responsibility between

resident and attending

• Create a culture of regular and honest communication for the benefit of the residents’ education and future success

• Need an effective team– Faculty, staff, residents, institution

(colleagues / legal)

Program Planning

• Build “Your Team”

• Organized and structured to regularly evaluate and provide feedback

Need Faculty Committment

• Your colleagues are critical to program development

• “Buy-in” and support

• Open lines of communication between all players (including the residents)– Honest and constructive

evaluation and feedback

A B

Medical Student Competent Orthopaedic Surgeon

A B

Medical Student Competent Orthopaedic Surgeon

SETTING EXPECTATIONS

A B

Medical Student Competent Orthopaedic Surgeon

Start of residencyStart of specific rotationStart of year in training

Bogerd

• Background

• Opportunity

• Goals

• Evaluation

• Rescue

• Deal

FREQUENT (and early) EVALUATION

AB

Formative Evaluation

Formative EvaluationMidrotation

Formative Evaluation

Summative EvaluationBogerd

Start of specific rotation in training

AB

Formative Evaluation

Formative EvaluationMidrotation

Formative Evaluation

Summative EvaluationBogerd

Start of specific rotation in training

DOCUMENT DOCUMENT

PROVIDING FEEDBACK

Pendleton Rules

• Bulstrode and Hunt (1997)– Adapted from Pendleton, a British marriage

counselor

• Provides a method for providing feed-back– Formalizes the process– Makes the encounter non-threatening to the

resident– Makes it less personal for the attending

Pendleton’s Rules

1) Teacher asks learner what went well from learner’s perspective

2) Teacher tells learner what went well from teacher’s perspective

3) Learner is asked what they could have done differently

4) Teacher provides input on what they believe could have been done differently

DOCUMENTATION

Documentation• Document early and often

• Have scheduled evaluations for each service rotation – pre - mid - final

• Residency Director– Review all evaluations– Look for patterns, red flags– Biannual all faculty and chief resident review

of all residents

Pitfalls• Evaluation – “We don’t do it”

– Tendency to be “supportive”, not objective• Lack of documentation

– “too little, too late”• Lack of feedback to resident• Lack of communication with other faculty

– Is yours an isolated event (that you brush off) or a recurrent theme?

SUMMARY

• Start with Resident Selection

• Know your “Due Process” up front

• Build your team

• Set Expectations

• Frequent Evaluation

• Provide Feedback

• Honest Constructive Documentation!

THANK YOU