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expected performance outcomes, the following should be defined in advance and
adhered to scrupulously:

• Time frame for remediation


• Prescribed learning activities


• Adjustments to schedule (decompression, repeat of previous rotation)


• Monitoring and feedback process


• Schedule and criteria for reassessment


• Consequences for not meeting the expected standards

The outlined criteria for reassessment should delineate any assessment activities
that are not part of the program’s regular performance assessment structure, such as
additional standardized objective clinical examinations. Because of limitations in
supervisor rotation evaluations described earlier, it is best to avoid using “satisfac-
tory performance on all rotation evaluations” as an expected outcome. A more
appropriate approach is “satisfactory performance as adjudged by the CCC.” To
reinforce accountability, the plan may be signed by the program director and the
resident.
An essential component of any remedial program is the provision of prescribed
learning activities that are tailored to the problems and the resident’s learning needs.

Table 17.4 Examples of behavior-based performance outcomes

For a resident with dependability issues

You are expected to Your progress will be assessed via

Arrive promptly to all clinical and educational

activities

Complete all duty hour, charting, and other

residency administrative requirements in a

timely manner

Log all procedures within 1 week

Respond promptly and courteously to pages

and phone calls from clinical and

administrative staff

Attendance and punctuality for all clinical

and educational activities

Timely and satisfactory completion of all

rotational requirements, including medical

records and procedure logs

Prompt and professional response to all

emails, pages, etc.

Satisfactory performance as assessed by the

CCC

Absence of patient or staff complaints

For a resident with deficiencies in clinical reasoning and decision-making

You are expected to Your progress will be assessed via

Formulate an appropriate and complete

differential diagnosis for patients, and present

this to supervisors in an organized manner

Formulate an appropriate plan of care for

patients, and present this to supervisors in an

organized manner

Manage patient care, including answering

nursing questions, responding to patient care

concerns, and completing orders as appropriate

Proactively contact your chief resident or

attending if you are uncertain about how to

manage a patient

Successful completion of five observed

clinical encounters with reflection and

debriefing

Successful performance in verification of

proficiency exam in the skills lab, to be

scheduled in the last week of this plan

Improvement in mean rotation ratings for key

items

Absence of critical incidents or complaints by

patients or staff

Satisfactory performance as assessed by

the CCC

17 Optimizing Success for the Underperforming Resident