Remediation Policy | PCOM Graduate Medical Education
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Remediation Policy

Each residency program is responsible for assessing and monitoring each resident's academic and professional progress, including specific knowledge, skills, attitudes, and educational experiences required for residents to achieve competence in patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice, as well as adherence to departmental policies concerning resident education and the institution’s graduate medical education policies.

Failure to demonstrate an adequate fund of knowledge or professional decorum in any of these areas may result in remediation or more stringent disciplinary and corrective action if deemed appropriate.

Programs must ensure that evaluation and remediation processes are fair, timely, documented, and aligned with ACGME Milestones and Clinical Competency Committee (CCC) recommendations.

Procedures, Guidelines and Recommendations

This policy has been developed in accordance with ACGME guidelines to provide a fair and formative remedy, with due process, for residents who fail to meet expectations in the core competencies.

The CCC will review resident performance and may recommend remediation, probation, or other actions to the Program Director. Final decisions rest with the Program Director in accordance with institutional policy.

The objective of this policy is to provide formative feedback and encouragement to overcome deficiencies. In the event that a deficiency is persistent and inconsistent with the practice of medicine, this policy also provides guidance for due process leading to adverse actions such as extension of training, probation, or dismissal from the program.

In cases of egregious misconduct, serious professionalism violations, or threats to patient safety, the resident may be removed from clinical duties immediately and may be subject to accelerated disciplinary action, including suspension or dismissal, in accordance with institutional policies.

If a resident is identified as failing to meet the minimum requirements for progression in any core competency, faculty or residents will notify the Program Director and disclose the details of the concern. Concerns should be based on documented evaluations, direct observation, or other objective data whenever possible.

A Program Director may take any of the following actions and does not have to proceed through them in a consecutive manner.

Meeting and basic documentation

The Program Director will meet with the resident to discuss the deficiency or concern.

If the Program Director determines that no further action is warranted, no documentation will be placed in the resident's file.  However, if the program director feels the concern is sufficient to warrant documentation, then the concern and a plan for remedy will be placed in the resident's file.

The plan should include:

  • The specific deficiency linked to an ACGME competency
  • Expected outcomes
  • Timeline for reassessment
  • Methods of evaluation

If remediation is successful, the documentation will be removed from the resident's file upon graduation. Informal remediation is not reportable for future credentialing or licensing purposes.

Follow up

At least one follow-up meeting is required between the resident and Program Director to assess progress. Ongoing feedback should be documented and shared with the resident.

If a resident has previously met with the Program Director and received documented feedback, and a similar concern is again raised, or if a more serious infraction occurs, the Program Director will meet with the resident, document the details of the deficiency or offense, and place the resident on a performance improvement plan.

The performance improvement plan should include:

  • Measurable goals tied to competencies and Milestones
  • Defined educational interventions
  • Assignment of a faculty mentor or supervisor
  • Methods of reassessment
  • A clear timeline for reevaluation
  • Consequences of unsuccessful remediation

The Program Director should inform the CCC and the Designated Institutional Official (DIO).

The resident is expected to sign the performance improvement plan, but if they refuse, then the terms will go into effect from the date that the Program Director’s signature is placed on the letter. They may also submit a written rebuttal. The resident must receive a copy of all documentation and be informed that if successfully completed, then the remediation will not be reported for future credentialing and licensing purposes.

Reevaluation will occur within a timeframe appropriate to the severity of the deficiency.

If a deficiency or offense has not been corrected satisfactorily, the resident will be placed on formal probation. Probation constitutes a reportable adverse action and must be clearly communicated in writing.

Curriculum credit may be withheld pending the outcome of probation. Moonlighting privileges, if previously granted, will be suspended.

The Program Director must include input from the CCC and must inform the DIO.

Required Documentation

Documentation must include:

  • The nature of the deficiency
  • Prior remediation efforts
  • Evidence supporting the decision
  • Specific corrective actions required
  • A defined timeline for reevaluation
  • Consequences of failure to successfully pass probation
  • A statement that probation is reportable for future credentialing and licensing purposes
  • A statement outlining the resident’s right to appeal

The resident is expected to sign the probation letter, but if they refuse, then the terms will go into effect from the date that the Program Director’s signature is placed on the letter. The resident may also choose to appeal the recommendation for Level 3 Probation by initiating the formal resident grievance process (see Policy on Grievance and Appeal).

Reevaluation

Reevaluation will occur at a defined interval and include objective assessment methods.

If probation is successfully completed, documentation of the passing of probation will remain in the resident’s file and will be reportable for future credentialing and licensing purposes.

If patient safety is at risk, the resident may be immediately removed from clinical duties and placed on administrative leave pending investigation. This action is not disciplinary in itself but may lead to further action.

If a resident fails to meet the conditions of probation or if a serious issue warrants dismissal, the resident will be dismissed from the program.

The Program Director will compile documentation, including:

  • The nature of the deficiency
  • Clinical or professional context
  • Summary of prior remediation and probation efforts
  • Evidence supporting dismissal
  • A statement that dismissal is reportable

The Program Director will present the recommendation for dismissal to the DIO for approval prior to implementation, except in cases requiring immediate action for patient safety.

Resident Rights

The resident must be informed of:

  • The reason for dismissal
  • The effective date
  • The right to appeal
  • The process and timeline for appeal

Due Process

All residents are entitled to:

  • Timely written notice of deficiencies
  • Opportunity to respond
  • Access to grievance and appeal procedures
  • Fair and unbiased review

Non-Retaliation

Residents will not face retaliation for reporting concerns or participating in grievance or appeal processes.

Documentation Standards

All actions must be documented contemporaneously, maintained securely, and accessible to the resident.