Association of Vascular Surgery Coordinators Dealing With Problem Residents Peter J. Pappas, M.D. Professor of Surgery Program Director: New Jersey Medical School Vascular Surgery Residency
Qualifications • Vascular Surgery Program Director for 10 years. • Traditional 5 + 2 training program • General Surgery Program Director for 4 years • Second largest residency program in country • 86 categorical, non-designated and designated preliminary residents • One to two problem residents in each PGY-year per year.
Academic Issues Failure to progress Poor knowledge acquisition, poor clinical judgement, patient safety issues and so on. Learning Disabilities AADD Dyslexia Substance Abuse Alcoholism Drug Dependence Non-Academic Issues Sexual Harassment Racial Discrimination Residency verification for Hospital priviledging What do you report if the above occurred? Definition of a “Problem” Resident
CIR 2009-2010 Contract
Grievance And Disciplinary Procedures
Identification of Specific Issue • First line of defense is the rotation evaluations • Rotation evaluations will often be first notification of a potential problem. • Monthly/Bi-monthly residency review committee is crucial • Oral discussions reveal issues not documented in rotation evaluations. • Documentation of the oral discussions in the semi-annual evaluation is crucial especially if items not documented in rotation evaluations are discussed.
Residency Review Committee Meetings • Avoid personality discussions. • Use competencies to identify, dissect and specify exact academic issue. • Develop uniform set of phrases that explain the deficiency identified. • Use these phrases in semi-annual evaluation. They will serve as the basis for a remediation plan if necessary.
Competency Deficiency Phrases • Knowledge Base • Poor fund of textbook knowledge for current PGY level. • Poor textbook knowledge base foundation. • Clinical Judgement • Inability to translate textbook knowledge into clinical decision making.
Competency Deficiency Phrases • Oral presentations • Inability to present pertinent data in a succinct manner during walk rounds. • Demonstrates disorganized and illogical thought processes during formal oral and written presentations.