title: Defining Uniform Processes for Remediation, Probation and Termination in Residency Training.
abstract: It is important that residency programs identify trainees who progress appropriately, as well as identify residents who fail to achieve educational milestones as expected so they may be remediated. The process of remediation varies greatly across training programs, due in part to the lack of standardized definitions forgood standing, remediation, probation, and termination. The purpose of this educational advancement is to propose a clear remediation framework including definitions, management processes, documentation expectations and appropriate notifications.Informal remediationis initiated when a resident's performance is deficient in one or more of the outcomes-based milestones established by the Accreditation Council for Graduate Medical Education, but not significant enough to trigger formal remediation.Formal remediationoccurs when deficiencies are significant enough to warrant formal documentation because informal remediation failed or because issues are substantial. The process includes documentation in the resident's file and notification of the graduate medical education office; however, the documentation is not disclosed if the resident successfully remediates.Probationis initiated when a resident is unsuccessful in meeting the terms of formal remediation or if initial problems are significant enough to warrant immediate probation. The process is similar to formal remediation but also includes documentation extending to the final verification of training and employment letters.Terminationinvolves other stakeholders and occurs when a resident is unsuccessful in meeting the terms of probation or if initial problems are significant enough to warrant immediate termination.
authors.affiliation: Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Smith
authors.affiliation: University of Michigan, Department of Internal Medicine, Ann Arbor, Michigan.
authors.forename: Monica
authors.initials: M
authors.lastname: Lypson
authors.affiliation: SUNY Downstate/Kings County Hospital, Department of Emergency Medicine, Brooklyn, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Silverberg
authors.affiliation: Staten Island University Hospital, Northwell Health, Staten Island, New York.
authors.forename: Moshe
authors.initials: M
authors.lastname: Weizberg
authors.affiliation: Columbia University Medical College-NY Presbyterian Hospital, Department of Emergency Medicine, New York, New York.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Murano
authors.affiliation: University of Michigan, Department of Internal Medicine, Ann Arbor, Michigan; University of Michigan, Department of Pediatrics, Ann Arbor, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Lukela
authors.affiliation: University of Michigan, Department of Learning Health Sciences, Ann Arbor, Michigan.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Santen
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004282:Documentation / Q000379:methods*; D004503:Education, Medical, Graduate / Q000592:standards*; D004521:Educational Measurement / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D014481:United States