Resident in Difficulty:  A Guide to Due Process

1. The Evaluation Process

1. Initial Problem Identified

1. All residency personnel are encouraged to provide direct feedback to residents on a daily basis regarding routing concerns.

2. When problems are more serious, or of a repetitive nature, the resident's advisor should be notified without delay. This will initiate the first step of the evaluation process, involving information gathering. The resident will be informed that this process has been initiated.

3. As soon as possible, the advisor will inform the faculty and chief resident(s) that this process has been initiated.  

4. Step B is initiated if the problem is not resolved within 30 days.

5. Observation, probation, or suspension may be immediately initiated during this stage if a problem is identified that is deemed sufficiently serious.  

2. Observation Cycle

1. Specific assignments or guidelines will be prescribed by the advisor with faculty input. The chief resident(s) will be part of these discussions in order to provide input and information that may have bearing on the resident's case.

2. The period of this observation should be from 1-3 months, preferably one month.

3. Feedback will be provided monthly.

4. If the problem is not resolved, the issue becomes probationary.

5. Probation or suspension may be immediately initiated during this stage if a problem is identified that is deemed sufficiently serious.

6. Successful completion of observation requirements will result in reinstatement of the resident in good standing. If the problem recurs following completion of the observation period, the faculty will determine an appropriate level of intervention.

7. Any problem which reoccurs after two observation cycles automatically becomes probationary.

8. If certain of the observation requirements have been satisfied, but others remain problematic, the faculty has the option of extending the observation period to allow for completion of the remaining requirements.

2. The Probation Process

1. Probation Cycle

1. Resident issues that lead to probation are by definition those that have failed observation or infractions deemed serious enough to warrant probation. Failure of a rotation, unprofessional behavior, or significant breach of standard of care are examples of events that alone could cause probation to begin immediately.

2. The resident will be notified as soon as possible of probationary status, even if formal documentation of the problem is pending. If the latter is true, he/she will be informed of pending probation by both the advisor and program director.

3. The chief residents will be included in subsequent discussion about the resident's case.

4. An ad hoc committee of three faculty members, including the resident's advisor, will formulate a probationary letter. The faculty will review the probationary plan generated by the ad hoc committee.

5. The probationary letter will contain the following:

1. Reason for probation (deficiencies)

2. Statement clarifying probationary status

3. Length of probation (not to exceed 90 days)

4. Specific expectations necessary to meet probation requirements

5. Assistance that will be available to meet those

6. The mechanism for measuring improvement (clearly defined standards)

7. Consequences of failure to meet probationary requirements

6. The resident will receive monthly feedback on his/her performance and additional corrective steps may be instituted to help the resident successfully complete the problem.

7. The ad hoc committee will assess the results of the resident's performance during the probationary period and inform the faculty of its findings.

8. Successful completion of probationary requirements will result in reinstatement of the resident in good standing.

2. Recurrence of behaviors or practice errors that initiated probation will result in immediate resumption of probation or non-renewal of the resident's letter of agreement.

3. Residents on probation cannot seek or hold residency office and may be relieved of other ancillary duties such as applicant interviews or curricular chairmanship.

4. Records of probation actions are kept in the resident's file in the residency office and may be released to future employers and credentialing committees if requested.