540 - How do programs identify, support, and track resident remediation?

Poster Number: 540
Publication Number: 540.324

Elizabeth Nelsen, Upstate Golisano Children's Hospital, Syracuse, NY, United States; David Mills, Medical University of South Carolina, Mt. Pleasant, SC, United States; Nicola Orlov, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, Chicago, IL, United States; Nathaniel Goodrich, University of Nebraska College of Medicine, Omaha, NE, United States; Su-Ting T. Li, University of California Davis, Sacramento, CA, United States

Background: Remediation is defined as additional goal-directed training, supervision, or assistance imposed on a learner beyond what is typically required by a specialty. It is based on a decision that the performance or conduct of a learner falls short of program requirements. Evidence is lacking to guide best practices in remediation. Residency program directors invest a lot of time, energy, and resources in providing underperforming learners with remediation plans aimed at achieving competence and ensuring patient safety.

Objective: One objective as part of a bigger study was to learn how pediatric residency programs identify, support, and track residents who require remediation.

Design/Methods: A survey on resident remediation practices was developed by a workgroup of APPD members using an iterative process. It was electronically distributed to APPD member programs by the Research and Scholarship Learning Community.

Results: Of 195 programs surveyed, 99 programs responded (50.8%). All programs use the Clinical Competency Committee (CCC) assessment to identify residents who require remediation. Other criteria include rotation evaluations, direct observation, verbal feedback, milestone scores, multi-source/360 evaluations, in-training exam score, and Entrustable Professional Activities. Programs document resident remediation progress using written improvement plans (88.8%). Many use rotation evaluations to determine if a resident has achieved the goals of remediation (93.3%). Other tools include documentation of resident adherence to the plan and verbal feedback. About half of programs do not apply a standard duration to remediation (58.4%). Of programs that do (n=37), many use 3 months as the term at the end of which a decision must be made on a resident’s progress (81.1%). The most common frequency with which the person responsible for oversight of the plan meets with the resident is monthly (32.6%). About 14% of programs indicated that duration depends on the resident, the reason for remediation, and what the plan entails. Programs were also asked to evaluate different methods of remediation for the six core competencies. Methods using direct observation and faculty mentorship/coaching were consistently found to be very effective/effective regardless of competency.

Conclusion(s): Pediatric residency programs employ different strategies for identifying, tracking, and supporting struggling residents with some similarities across programs. These results highlight the need for a remediation model with clearly defined elements geared towards ensuring equity in remediation while reducing the burden for programs.