Surgeons as Educators A Guide for Academic Development and Teaching Excellence

(Ben Green) #1
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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

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