280
intervention should occur sooner rather than later, as early identification of, and
feedback about, underperformance or problem behaviors can help modify behaviors
before they become more serious or refractory to change [ 29 ]. At a minimum, this
fact-finding phase includes assessing the initial report(s) for validity and severity;
reviewing other available data such as past evaluations, milestone assessments,
CCC discussions, 360-degree evaluations, etc.; and meeting with the resident, to
incorporate the resident’s perspective of the problem. In meeting with the resident,
it is very important to approach the subject with an attitude of concern and assur-
ance that the goal is to help the resident be as successful as possible. Discussion of
the areas of concern should be accompanied by clear information on the expected
performance outcomes or behaviors. Residents receive this initial news with vary-
ing degrees of insight and receptiveness and generally require multiple conversa-
tions to process the information. When a resident presents with significant deficits
in clinical performance or judgment, a program director will need to decide, after
careful review of institutional policies, whether the resident can continue to practice
safely under supervision or if the deficits are so severe that they need to be removed
from clinical service to preserve patient safety while a clear educational formulation
and remediation plan are being developed. In these instances, it is vital to include
appropriate GME office leaders, human resources, and/or legal representatives in
the discussion. Commonly described performance deficits are listed in Table 17.1.
An underperforming or problem resident is likely to have deficits across multiple
competency and performance domains. Although deficits may occur across all
Table 17.1 Common
performance deficits
Interactions or relationships with others
Insufficient knowledge/ITE score
Technical skills
Communication skills
Case presentations
Effective handoffs
Clinical judgment
Clinical reasoning
Data interpretation
Ability to put everything together
Decision-making
Ability to manage patients
Dependability
Punctuality
Absences
Medical records delinquency
Bad attitude/lack of apparent interest or motivation
Lack of honesty or trustworthiness
Time management
Slow pace of work
Inappropriate, disruptive, unethical, or illegal behaviors
Adapted from Williams et al. [ 4 ] and Tabby [ 6 ]K. Broquet and J.S. Padmore