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The Appeals Process
The ACGME requires each Sponsoring Institution to have a policy that provides
residents/fellows with due process relating to the following actions regardless of
when the action is taken during the appointment period: suspension, nonrenewal,
non-promotion, or dismissal [ 19 ]. Many institutions have structured “hearings” or
multiparty review panels to hear and decide upon resident appeals. However, there
is no requirement for a “hearing” or even a panel consisting of multiple people. Due
process can be as simple as a meeting, with a single neutral reviewer. Padmore,
Richard, and Filak [ 57 ] describe review processes in detail, demonstrating that a
single reviewer can be more effective and less resource intensive than a hearing or
review panel.
The appeals process should be limited to assuring that (a) departmental/hospital/
university policies were followed, (b) the resident received notice and opportunity
to cure [or be heard], and (c) there was a reasonable decision-making process and
(d) determining if there were any extenuating circumstances that have not previ-
ously been considered. If all of these items are in compliance, then it is generally
inappropriate for a review panel to change or reverse the decision of a department
regarding competence or performance.
The Final Summative Evaluation
The ACGME requires the program to prepare a final summative evaluation (FSE)
for each resident [ 58 ]. The FSE should be competency based, fair, and balanced and
provide a narrative assessment of the entirety of the resident’s performance in your
program. The FSE should be comprehensive enough that it is maintained as the
historic document of record describing the performance of the trainee for decades to
come. The FSE should be provided upon request to other training programs, licens-
ing boards, and credentialing bodies. It is good practice to provide the resident with
a copy of the FSE upon departure from the program. The FSE for an underperform-
ing resident, or a resident who has been dismissed from the program, can be espe-
cially important. The FSE should be carefully written and honest. The FSE is very
different from a letter of recommendation (LOR). The FSE is comprehensive and
balanced. Letters of recommendation are intended to be positive and written to per-
suade another decision-maker and generally do not include both strengths and
weaknesses. Departments should have a policy on who can write letters of recom-
mendation and under what circumstances. The institution can have substantial risk
when dismissing a resident, if conflicting messages in the form of the FSE and LOR
are communicated to others.
Summary
In this chapter, we have reviewed steps in identifying, clarifying, and addressing
deficiencies in resident performance. Performance issues are most commonly
identified via direct observation of clinical skills by faculty, standardized cognitive or
K. Broquet and J.S. Padmore