GME POLICY #703
PERFORMANCE ALERT & REVIEW (PAR) NOTICE CHECKLIST
PERFORMANCE ALERT & REVIEW (PAR) NOTICE
PROGRAM DIRECTOR CHECKLIST
Resident/Fellow: _____________________________________________________________
Program: ___________________________________________________________________
Steps A-E must be completed to satisfy the requirements for a Performance Alert and Review Notice,
possibly including Remediation Plan or Probation.
A.
Prior to Placement Alert or Remediation:
Action
1. Formal PAR Notice completed including the
following required elements:
a. Deficiency/deficiencies identified and
documented
b. Deficiency/deficiencies linked to ACGME
competencies
c. Methods for remediation documented in
writing
d. Remediation outcome measures identified
e. Time period (___ months) for remediation
documented in writing
2. Schedule formal meeting with
Resident/Fellow
B.
Comments
Date Completed
Comments
Date Completed
Notification of Remediation or Probation:
Action
1. Formal meeting with Resident/Fellow
2. Details of PAR Notice and remediation plan or
probation discussed with Resident/Fellow
3. Resident/Fellow and Program Director sign
PAR Notice
4. Copy of signed PAR Notice given to
Resident/Fellow at conclusion of meeting
5. Copy of signed PAR Notice delivered to GME
office for the DIO (within 3 days of meeting)
6. Original PAR Notice filed in Resident/Fellow
training record
Sponsoring Institution: University of Tennessee College of Medicine Chattanooga
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C.
Monitoring of Remediation or Probation Progress:
Action
1. Schedule all end of month meetings with
Resident/Fellow and inform Resident/Fellow
in writing
2. Month 1 meeting and written progress report
a. Resident/Fellow signature
b. Copy to Resident/Fellow
c. Original to Resident/Fellow training record
3. Month 2 meeting and written progress report
a. Resident/Fellow signature
b. Copy to Resident/Fellow
c. Original to Resident/Fellow training record
4. Month 3 meeting and written progress report
a. Resident/Fellow signature
b. Copy to Resident/Fellow
c. Original to Resident/Fellow training record
D.
Comments
Date Completed
Comments
Date Completed
Conclusion of Remediation period:
Action
1. Schedule conclusion of Remediation meeting
with Resident/Fellow
2. Conclusion of Remediation meeting and
written progress report – item 3 or 4 selected
based upon outcome
3. Satisfactory Remediation and all requirements
completed – formal letter indicating
satisfactory performance, removal from
Remediation Status, and return to full duty
a. Resident/Fellow & Program Director
signature
b. Copy of signed letter to Resident/Fellow
c. Copy of signed letter to GME Office for
DIO (within 3 days)
d. Original letter placed in Resident/Fellow
training record
4. Unsatisfactory or incomplete Remediation –
formal letter indicating unsatisfactory
performance and one of the following (require
prior approval by the DIO):
a. Placement on a second Remediation period
b. Disciplinary action including but not
limited to probation, suspension, or
dismissal
c. Non-reappointment
Sponsoring Institution: University of Tennessee College of Medicine Chattanooga
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E.
Outcome of Remediation/Probation:
All of the Remediation/Probation essential expectations outlined above have been completed as
documented.
Dr. ______________________________________________________ is:
(check appropriate action):
□
□
□
□
□
Returned to full duty effective: ____________________
Placed on 2nd Remediation period effective: ____________________
Placed on Probation or Suspension effective: ____________________
Notified of non-reappointment effective: ____________________
Dismissed effective: ____________________
____________________________________
Program Director Signature
____________________
Date
__________________________________________
Associate Dean/DIO Signature
____________________
Date
Reviewed and approved by the GMEC 2/22/2011.
Revised 6/28/2014 and approved by the GMEC 7/15/2014.
Sponsoring Institution: University of Tennessee College of Medicine Chattanooga
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