1. Residents in Difficulty: The Good, the Bad and the Ugly
Suzanne Allen, MD, MPH
Catherine Serio, PhD
March 1, 2007

2. Overview Case Introductions Underlying Issues Developing Due Process
Case Conclusions

3. The Case of Jack
Jack completed osteopathic school and began at FMRI. Well liked, friendly, outgoing, helpful, team player, genuinely wants to help patients and others.
Fall of intern year received marginal pass on inpatient medicine. Put on reading program, increased observation, videotaping with feedback. No formal due process in place at FMRI.

4. The Case of Jack
Jack successfully completes internship and begins second year. Ongoing concerns by individual faculty.
Failed internal medicine rotation May of second year. Put on probation.
Successfully repeated internal medicine rotation in August. Put into remediation.

5. The Case of Jill
Jill began at FMRI after completing allopathic medical school, starting OB/GYN residency which she stopped after 2 months, starting pediatric residency which she stopped after 10 months.
Begins with non-call rotations because of pregnancy, one call month at local VA prior to delivery.

6. The Case of Jill
First call rotation in February of first year on OB some concern by fellow residents about her ability teamwork.
Second call rotation in March of first year on internal medicine concern by faculty regarding medical knowledge and ability to care for patients. Marginal pass for this rotation. Placed in first step of observation.

8. Underlying Issues Defining the Problem Resident? Faculty? Cognitive
Behavioral/Attitudinal
Legal
Impairment
Faculty?
Roles
Peer relationships
Conflict Management styles

9. Exposing Dynamics Launching Safe Doctors Rescuing Victims
Pre-existing conflicts, alliances
Managing Disagreement
Broken Data Sets

10. Underlying Issues Agreeing on a Minimum Standard Legal Angles
Essential Job Functions
Legal Angles
Contracts
ADA
Due Process
Faculty, Resident, Board buy-in
Formal request for accommodation
Identifying Resources
Mental Health, LD, Impaired physicians, Legal

14. The Case of Jack
Ongoing concerns by faculty in clinic and hospital. Suspended December of third year.
Jack appeals to Board of Directors.
Re-instated January of third year.

15. The Case of Jack
Continued concerns about ability to multi-task, diagnose the undifferentiated patient in family medicine.
Resigned from FMRI in April of third year and entered PM&R residency which he successfully completed.

16. The Case of Jill
At completion of observation, recommended a corrective action plan of 6 months.
Plan included reading plan, case presentations to faculty, videotaping with review.

17. The Case of Jill
Jill requested an extension of her residency which was granted.
Returned to resident in good standing at completion of corrective action plan.
Ongoing teamwork, professionalism concerns by fellow residents, faculty and other providers at clinic.