1. 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

2. 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.

3. 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

5. CIR 2009-2010 Contract

6. Grievance And Disciplinary Procedures

7. 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.

8. 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.

9. 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.

10. 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.