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For residents struggling with problematic non-cognitive learning behaviors unre-
lated to psychiatric illness, assessment by an educational specialist may be helpful.
High-yield non-cognitive behaviors that are most likely to benefit from a perfor-
mance and learning strategy intervention include organizational skills, time man-
agement, cognitive skill development, interpersonal or communication skills, or
test-taking difficulty. A resident with a pattern of chronic non-compliance with pro-
gram policies, expectations, or follow-up on prior educational interventions is not
likely to benefit from this type of assessment.
When a resident has extraordinary external stresses or has disclosed a psychiatric
illness, both the program director and the faculty must be very careful to keep their
compassion and empathy for the resident separate from the expectations for perfor-
mance standards. Mental health treatment or learning strategy assistance may be an
important part of a remedial plan to assist the resident to succeed, but participation
in such is not a reasonable performance outcome measure. Residents should be
educated to consider requesting a medical accommodation to allow for extra assis-
tance to perform the essential duties of their job.
In assessing for underlying causes, a program director must be open to the pos-
sibility that causative factors may lie within the program rather than within the resi-
dent. Excessive clinical volumes or call demands may be exceeding the capabilities
of residents with more limited reserves. If a resident is exhibiting unprofessional
behaviors, being rude to subordinates, or throwing things in the OR, he or she may
be emulating behaviors that are being role modeled by faculty. It is not uncommon
for an underperforming resident to perceive that they are being held to a different
standard than another resident. Academic decisions for individual learners are made
based on individual factors and review of the entire academic record.
Developing a Learner-Centered Remediation Plan
Remediation may carry different connotations for different institutions. For some,
remediation may imply a formal institutional action, such as letter of deficiency or
academic probation. For others it may encompass an informal warning status.
Remediation programs may include focused activities that parallel regularly sched-
uled rotations, repeated rotations or experiences within a standard length of train-
ing, or extension of training. In this chapter, we define remediation broadly as “the
process of improving or correcting a situation” [ 42 ]. As an adult learner with
expected competence in practice-based learning and improvement, the resident
should be actively involved in developing the plan. As described by Hauer et al. [ 23 ]
and Sullivan and Arnold [ 29 ], a sensible remediation plan requires the articulation
of clear goals and expectations for acceptable performance. The goal of any reme-
diation is behavioral change. Therefore, the expected outcome behaviors should be
as specific as possible. (See Table 17.4 for examples).
Development of a remediation plan should be guided by sound educational prin-
ciples as well as program and institutional policies on academic progression and
due process. In addition to a clear description of the performance deficits and
K. Broquet and J.S. Padmore