295Conducting an inquiry does not mean trying to be a police detective or basing
decisions on irrefutable evidence. In fact, many times, the person conducting the
inquiry may receive ambiguous information or nuanced information from many
sources. A misconduct inquiry is not a court trial; the program director should gather
as many facts as possible in order to make the best possible decision.
In some situations, a program director may determine that the resident in fact did
engage in misconduct, but either made an honest mistake or has faith that the resi-
dent can learn from the situation and improve. Only after an inquiry can this deter-
mination be fairly made. If the program director determines the resident should be
given another chance to show they can learn from the misconduct, then remediating
under the competency of professionalism is an appropriate next step.
Documentation
When defending a legal case, contemporaneous documentation of events, actions, or
conversations is very helpful in determining whether or not something actually hap-
pened. While there is no law that requires evaluations or performance feedback to be
written, the ACGME requires written rotational evaluations and semiannual evalua-
tions of performance. Of course, it is natural within an academic clinical setting that a
faculty member provides a resident/fellow with routine verbal feedback. Although it
is not recorded, this verbal feedback constitutes notice and opportunity to cure [ 55 ].
While it is always helpful to have written performance documentation, lack
thereof should not deter evaluators from doing the right thing and utilizing this
information as part of the overall evaluation process. One critical role of the CCC is
to elicit feedback from faculty members regarding performance in a variety of set-
tings and situations and for the faculty to discuss performance based on individual
experiences and opinions. In many situations, this discussion at the CCC may be the
first time that issues emerge and indicate a pattern of performance or behaviors.
This discussion is the heart of the CCC and should not be discounted just because
there is not a rotational evaluation or other assessment tool or form to support the
discussion. Research shows that the discussion among the faculty members in the
CCC often provides more accurate and robust information regarding learner perfor-
mance than the written evaluation alone, which may not represent a complete view
of actual performance (see previous section on the CCC).
Question to consider: How does this information provided by the resident
change this situation? Since the resident was acting under the direction of the
associate program director, does it change your view of the situation? If you
had not received this information, how would your decision-making process
have been different in this scenario? What steps should you take now that you
have more information?17 Optimizing Success for the Underperforming Resident