title: Remediation of problematic residents--A national survey.
abstract: OBJECTIVE
  Despite careful selection processes, residency programs face the challenge of training residents who fall below minimal performance standards. Poor performance of a resident can endanger both patient safety and the reputation of the residency program. It is important, therefore, for a program to identify such residents and implement strategies for their successful remediation. The purpose of our study was to gather information on evaluation and remediation strategies employed by different otolaryngology programs.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  We conducted a national survey, sending a questionnaire to the program directors of 106 otolaryngology residency programs. We collected information on demographics of the program, identification of problematic residents, and remediation strategies.
  
  
  RESULTS
  The response rate was 74.5%, with a 2% cumulative incidence of problematic residents in otolaryngology programs during the past 10 years. The most frequently reported deficiencies of problematic residents were unprofessional behavior with colleagues/staff (38%), insufficient medical knowledge (37%), and poor clinical judgment (34%). Personal or professional stress was the most frequently identified underlying problem (70.5%). Remediation efforts included general counseling (78%), frequent feedback sessions (73%), assignment of a mentor (58%), and extra didactics (47%). These remediation efforts failed to produce improvement in 23% of the identified residents, ultimately leading to their dismissal.
  
  
  CONCLUSIONS
  The apparent deficiencies, underlying causes, and remediation strategies vary among otolaryngology residency programs. Based on the results of this survey, we offer recommendations for the early identification of problematic residents and a standardized remediation plan.
  
  
  METHODS
  NA.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Nasir I
authors.initials: NI
authors.lastname: Bhatti
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Aadil
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Stewart
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Miller
authors.affiliation: Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Sukgi S
authors.initials: SS
authors.lastname: Choi
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D007396:Internship and Residency; D010036:Otolaryngology; D011795:Surveys and Questionnaires; D014481:United States; D000066477:Work Performance
keywords: Remediation; otolaryngology residency; problematic residents