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ensuring that every supervisor provides frequent, honest, and accurate performance
feedback to all residents. Learners who are not exposed to feedback early in their
training tend to become less receptive to it as they progress. Frequent feedback also
reinforces that the assessment system is a just one. If informal feedback is occurring
on a regular basis, there should be no surprises for the resident at more formal
assessment points [ 48 ].
Remediating a resident with significant performance problems is stressful in the
best of circumstances. Sometimes, even in the presence of frequent, honest, and
accurate feedback, if the resident lacks insight about the deficits or has significant
interpersonal difficulties, the process can become adversarial. Organizing and
implementing a remediation plan for a willing resident take a significant amount of
faculty time and effort. If the resident is angry or repeatedly challenges feedback
and performance assessment, it can become emotionally draining as well.
Nonreflective residents may want to revisit and parse the details of every incident or
complaint instead of reflecting or looking at the larger pattern. It is important to
allow the resident a forum to have his or her concerns heard, addressing any that
may be reasonable while taking care not to get sidetracked by repeated discussions
of incident details that have already been thoroughly evaluated and discussed.
Consistently and firmly refocus the discussion to the discrepancy between the
expected standards of the program and the resident’s performance and behavior. No
matter how challenging the resident is, it is wise to not respond with anger and to
avoid the temptation to diagnose any personality issues, as that has no bearing on
the performance standards. The most important thing for the program director to
remember is that resident training is a collective effort. Fellow program directors,
departmental chair, faculty members, the DIO, and human resources or legal col-
leagues can all be valuable sources of support.
How Do You Know if Your Remediation Is Successful?
Knowing if and when a given intervention or remediation for a resident has been
successful is a difficult issue for program directors and CCCs. The success rate for
an intervention for a discrete medical knowledge deficit, such as in-training exam
performance, may be 75–100% [ 17 , 18 , 49 ]. Remediation is generally more suc-
cessful for deficiencies in medical knowledge and least successful for problems in
professionalism, communication, and interpersonal behaviors [ 1 , 6 , 17 , 18 , 49 , 50 ].
Papadakis [ 51 – 53 ] has reported an association between professionalism concerns in
medical school and residency and disciplinary action by a medical board but did not
include info on whether attempts at remediation had occurred. For many residents,
especially those with deficiencies in multiple areas, the deficits may persist over
time, and repeated episodes of remediation may be needed [ 2 , 6 ].
Graduation rates from 52% to 94% have been reported for identified underper-
forming residents, with lower rates corresponding to those residents on formal
academic probation status [ 3 , 4 , 6 , 7 , 9 , 14 ]. The interpretation of graduation rates
K. Broquet and J.S. Padmore