Table 1.
Summary of recommended steps for fair and defensible processes leading to termination of training
| Steps for fair and defensible processes leading to termination of residency training | Core concepts | |
|---|---|---|
| Part One | ||
| A. | Program Foundations: | |
| 1. | Ensure trustworthy assessment practices | Multiple expert assessors assessing the desired competencies using performance standards, doing this over time and contexts, documenting these assessments and having a system to interpret the collated data looking for patterns and trajectory |
| 2. | Ensure fair assessment practices | Clear relevant documented performance standards, opportunities for competency development, observation by informed assessors, clear feedback with ideas for improvement, followed by more opportunities for improvement |
| 3. | Provide holistic resident support | Evaluating for and attending to other factors that could be impacting resident performance |
| B. | Beginnings of Concerns: | |
| 4. | Make an educational diagnosis | Consideration of the situation holistically to determine the issue(s) negatively impacting clinical performance and addressing those |
| 5. | Bring concerns forward to an educational group | Separate informed body to review assessment data and any performance impacting factors to inform learning plans and summative decisions if need be |
| 6. | Start a documentation trail early | Documentation of all discussions and interventions pertaining to items 1-3, dated to create a timeline |
| Part Two | ||
| C. | Established Concerns | |
| 7. | Carefully create the remediation/probation plan | Use of an institutional template if available using deliberate unambiguous language with attention to practical and achievable interventions considering the reality of the workplace |
| 8. | Disseminate and review the plan with all involved. | Review of the plan with all involved ensuring program personnel (supervisors, education leaders) understand and can meet the requirements laid out in the plan and the resident has understood the plan and signed and dated each page as evidence of that understanding |
| 9. | Carryout the plan | Scrupulous attention to carrying out all elements of the plan. Support for all throughout |
| 10. | Determine the outcome | Outcome decision made by an independent assessment group |
| Part Three | ||
| D. | Challenges to program decisions: | |
| 11. | Preparation for the review | Review of all documentation and legal submissions and compiling evidence to justify the program decision |
| 12. | Participation in the review | Being adequately prepared for cross-examination both with documentation and mental mind set |
| E. | After the review. | |
| 13. | Improve program processes | Use of the review board’s findings to improve any weaknesses in assessment processes |
| 14. | Support the learner. | Career counselling if training is terminated |