All radiology residency programs should strive for the early identification of individuals in need of remedial training and have an approach ready to address this situation. This article provides a template for a step-by-step approach which is team based. It includes definition of the learning or performance issues, creation of suitable learning objectives and learning plan, facilitation of feedback and assessment, and definition of outcomes. Using such a template will assist the resident in returning to the path toward a safe and competent radiologist.
The academic rigor of radiology residency training is well known, indeed even among our peers in other disciplines. This reputation is appropriate given the breadth of anatomy, physiology, and pathology; requisite command of physics; and ever-evolving technology of our imaging modalities. It is a topic of discussion that appears in the postgraduate year 1 and reappears with increasing frequency to residents confronting the qualifying examination.
It should not be surprising then that program directors will occasionally encounter residents who are overwhelmed and may require remediation. Or alternatively, issues of professionalism may arise. The difficulty of this situation may be compounded by any combination of shame, embarrassment, denial, guilt, or delay in recognition. The latter problem has also been described as a “failure to fail.”
At the behest of our Postgraduate Medical Education office and national accrediting body, residency programs have improved efforts and mechanisms for the earlier identification of residents requiring formalized assistance with their medical knowledge, clinical skills, or professionalism. The value of timely detection in optimizing the chance for remedial success has been noted by multiple authors . There are, however, various factors which may obstruct this. Rather than documenting a resident’s poor performance, a supervisor may prefer to avoid an uncomfortable confrontation or the risk of reprisal through negative teaching feedback . As noted by Borus though and observed in our own department staff are often willing to verbally express concerns regarding a resident to the program director. This collaboration is helpful but leaves the director with limited options for response . Programs should instead strive to develop a culture of feedback which includes regular informal feedback and complete details on written evaluations.
Our current practice is to follow up on any such informal comments with further details and to flag any rotations that were failed or passed with reservations. The incorporation of milestones in training should also facilitate the recognition of trainees requiring remediation. These provide objective measures of residents meeting the expectations of their level of training. Programs will define at what point the unsuccessful achievement of milestones will constitute the requirement for remediation. Our Residency Training Committee (RTC) convenes four to six times per year. The resident members are excused before the conclusion of each meeting to allow for a faculty discussion of resident performance. This regular forum engenders insight from multiple perspectives and facilitates a consensus opinion on a particular resident’s requirement of remediation. The program recognizes the gravity of this decision, and such a process is valuable in alleviating the difficulty of this deliberation.
The timely recognition of such residents is only the initial task though. A customized plan for guidance, learning, and assessment must then be developed for each individual’s specific needs . Resident participation is a key aspect of the planning . In addition to possibly revealing other factors contributing to the resident’s difficulty , it will help affirm that the primary goal of the program is to assist the resident. Such an endeavor may quickly prove daunting in the face of particular learning issues of the resident, the preexisting demands on the teaching faculty, and the ongoing needs of the remaining residents. This article provides a step-by-step guide to a template for a remediation plan.
Remediation team
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Table 1
Various Activity Logs Required for Remediation Plan
Various Activity Logs Completion of background knowledge learning items
Meetings with remedial supervisor
Meetings with mentor
Meetings with rotation supervisor
Self-reflection commentary at the end of each clinical rotation
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Other Supports
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Background assessment
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Remedial objectives
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Learning plan
Rotations
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Fund of Knowledge
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Learning Activities for Clinical Performance
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Learning Activities for Professional Behavior
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The resident scheduled for call starting shortly that evening has an unexpected family emergency. Both chief residents are unavailable to fill in. You have long-awaited social plans for that evening but volunteer to cover the shift anyway.
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Table 2
Attributes of Professionalism
Adapted with permission from Cruess RL, Cruess SR, Steinert Y, eds. Appendix B. In Teaching medical professionalism. New York, NY: Cambridge University Press; 2009; 285–286.
Attributes of Professionalism
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Temporary Alterations in Clinical and Nonclinical responsibilities
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Oral Examinations
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Feedback and Assessment
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Table 3
Remediation Template Summary
Remediation Template Remediation team
Background assessment of resident
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Remedial objectives
Learning plan
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Outcome
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Outcome
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Summary
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References
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