ALBERT EINSTEIN COLLEGE OF MEDICINE
COMMITTEE ON GRADUATE MEDICAL EDUCATION
GUIDELINES for ACADEMIC SUPPORT and REMEDIATION
“The purpose of GME is to provide an organized educational program with guidance and
supervision of the resident.”1 For many years this statement served as the preamble to the
Institutional Accreditation Requirements of the ACGME, and provided a fundamental
perspective on the purpose of Graduate Medical Education.
This principle requires that residency and fellowship training programs create supportive
academic environments in which to encourage the professional growth and development of
competency of their trainees. Some trainees may experience difficulty in achieving the
performance and competency expectations of their residency program, however. They should be
provided with opportunities for Academic Support and Remediation before any “Adverse
Action”2 is taken.
I . Responsibilities: In the context of the academic relationship that exists between a resident
and a program, each has responsibilities.
A.
Programs:
1. Programs should inform residents of the standards and expectations of training:
1.1 A written curriculum should outline the knowledge and skill requirements of
the program.
1.2 Standards of evaluation, the requirements for advancement to the next
training level, and the requirements for completion of the program, all should
be clearly stated.
2. Programs should ensure supervision by appropriately qualified individuals:
2.1 Responsibilities for patient care in both inpatient and outpatient settings
should be clearly stated.
2.2 Assigned clinical duties should be consistent with the trainees’ levels of
competence.
3. Programs should evaluate resident performance in a timely manner.
3.1 Resident performance should be evaluated and formative feedback given for
each clinical rotation.
1 . Graduate Medical Education Directory, 2000-2003. Institutional Requirements. I. Institutional Organization and
Commitment. American Medical Association Chicago, IL. p. 22
2. The Hearing and Appeal Policy and Procedures for Redress of Adverse Actions of Montefiore Medical Center
define “Adverse Action” as to include any act which:
i. Prevents the resident from successfully completing the residency training program;
ii. Prevents the resident from successfully completing the current training year (or PGY level) in which the
resident is enrolled;
iii. Imposes a term of suspension; and/or
iv. Prevents the resident from achieving admissibility status to take the certification examination of the
American Medical Specialty Board in the specialty in which the residency program is conducted.
3.2 Formal evaluation/summative feed-back sessions should be conducted twice
yearly at a minimum, as prescribed by the ACGME.
B. Residents
1. Residents should review and learn the standards, requirements and expectations of
the training program.
1.1 Residents should read curriculum materials provided by the program.
1.2 Residents should understand the criteria by which they will be evaluated in
each of the ACGME general competencies.
1.3 Residents should understand the requirements for advancement from year to
year, and for completion of the training program.
1.4 Residents should raise any questions they may have to assure that they
understand the expectations of the program and the criteria for advancement
and completion.
2. Residents should accept professional responsibility for the provision of quality
patient care.
2.1 Residents should provide care consistent with their level of expertise
2.2 Residents should maintain compliance with applicable laws, and with the
rules, regulations, policies, procedures and by-laws of the medical staffs of the
participating hospitals in which they rotate.
3. Residents should evidence willingness to accept guidance, constructive criticism
and evaluation from the faculty.
4. Residents should demonstrate appropriate professional behavior.
II.
Procedures:
A. Files:
1. Each department should maintain a file of information pertaining to the
performance of each resident in its training programs.
2. The file should contain reports of performance on examinations (e.g. written inservice exams, structured observations of clinical competency, etc.).
3. The file should contain written evaluations from supervising attending physicians.
3.1 Written evaluations should be submitted in a timely manner.
3.2 Evaluations should include reference to knowledge and application of
information, skills, and professional behavior.
3.3 Additional materials that may be received from fellow residents, other health
care professionals, patients, etc. should be placed into a resident’s file.
B. Evaluation/feedback:
1.
Trainees should be provided with formative feedback as part of each rotation.
1.1 A written evaluation of resident performance should be submitted at the end
of each rotation.
1.2 Evaluations should include reference to each of the ACGME general
competency areas
2. At intervals, but no less frequently than every 6 months, the Program Director (or
appropriate faculty designee) should meet with each resident for a formal
feedback/evaluation session.
2.1 Composite summations of the evaluative materials in the resident’s file should
be presented. 3, 4
2.2 The resident’s strengths and areas for improvement should be enumerated,
with specific recommendations to achieve improved performance. The
resident should be advised with respect to progress toward completion of the
requirements for the curricular year and the program.
3. The resident should indicate by signature on the composite evaluation form that
the feedback/evaluation has been provided.
3.1 Should a resident disagree with an aspect of evaluation/feedback, s/he should
be offered the opportunity to submit a written statement outlining the points of
disagreement.
3.2 This statement should be included in the resident’s file.
4. A resident may be permitted to review his/her file, upon written request. The
review should take place in the presence of the Program Director or his/her
designee.
5. As required, there should be interim, ad hoc feedback to the resident.
C. Unsatisfactory academic performance. In the context of the academic nature of
residency training, when a resident is demonstrating unsatisfactory academic
performance, the first responsibility of the department is to provide support and
advice to help the resident improve.
1. The Program Director should provide clear and specific feedback on those aspects
of performance that are not at satisfactory levels of performance.
1.1 Written notation of feedback should be included in the resident’s file.
1.2 The file should indicate whether the resident has been placed in an academic
warning status or on “academic probation”.
2. The Program Director should recommend a remediation plan:
2.1 The Program Director should provide specific guidance as to how
performance should be improved.
2.2 A faculty mentor may be identified to provide close supervision for the
resident.
2.3 There should be specified the period of time during which the resident will
have the opportunity to demonstrate improved performance.
3. The Program Director may assist the resident in obtaining necessary counseling or
treatment if unsatisfactory performance is thought to be the consequence of
medical, psychiatric, or substance–induced impairment.
3 . It is not uncommon for faculty to be reluctant to make a written report of unsatisfactory performance,
particularly with respect to resident attitudes, motivation or behavior. Faculty expressing such concerns should be
assured that individual reports are treated confidentially to the extent permitted by law and by hospital policy. In
addition, the Program Director may draft a ‘memo to the file’ based on the verbal comments of a faculty member.
This, however, does not relive a faculty member of the responsibility to provide timely, written evaluation of
residents. Faculty are encouraged to provide fair, honest and meaningful commentary on resident performance, even
in cases when it is likely the resident will have access to the file.
4 . Each evaluation should include multiple categories, some of which may be more significant than others in the
context of the specific rotation to which the evaluation pertains. Residents also receive evaluations from many
individual observers, some of whom may be more experienced or more discriminating as evaluators. It is the
responsibility of the Program Director to create a composite evaluation that includes these considerations and to
explain to the resident the rational for weighting.
4. The Program Director should maintain accurate records of demonstrated
performance, feedback and remedial measures taken or contemplated.
D. Academic Failure after Remediation: Should a resident’s academic performance
continue to be unsatisfactory after an effort at remediation, the department may
recommend an action such as suspension, repetition of a portion of training, or
termination. These recommendations are consistent with the definition of “Adverse
Action” in the MMC Hearing and Appeal Policy and Procedures for Redress of Adverse
Actions and Grievances of Residents2. These also are actions subject to grievance under
the terms of the CIR Collective Bargaining Agreement with the New York City Health
and Hospitals Corp.5 In such situations, therefore, the resident will have recourse to the
due process and grievance procedures of her/his employing hospital system.
Approved May 2002
revised July 2007
5. JMC (CIR Collective bargaining agreement) “Grievance Procedures (pg 29)” Section 1
b.
A claimed violation…affecting the terms and conditions of employment;
d.
A question regarding the non-renewal of the appointment of an HSO;
And, “Disciplinary Action (pg 34)” Section 1;
“…There shall be no disciplinary action taken against an HSO except for cause….”