1. April Armstrong, BSc(PT), MD, MSc, FRCSC Associate Professor Chief Shoulder and Elbow Service Dept. of Orthopaedic Surgery and Rehabilitation Penn State Milton S. Hershey Medical Center Hershey, PA Developing a Remediation Plan for Underperforming Residents PREVENTION

2. Disclosure Consultant for Zimmer, Inc. –Not related to this presentation

3. Resident Selection “Don’t let them in your program” Don’t be blinded by scores or transcripts Take those you know are good –AI’s, Home students Emphasize the affective –Generate “discriminating” questions Remember that you are matching the candidate to your program- know your program

4. Resident Selection Be wary of those who circumvent your regular selection process –Transfers –“legacies” Follow up on recommendations if any question

5. Know your “Due Process” Know this in ADVANCE! Consult institutional legal and administrative experts different for each state and institution –all require documentation and evidence of attempts at remediation All resident evaluation can be part of Due Process –process built upon documentation, regular evaluation, and resident advocacy work is already initiated before any problem is seen and will be detected earlier

6. Program Planning “Be the Maestro” “Resident centric” –Shared responsibility between resident and attending Create a culture of regular and honest communication for the benefit of the residents’ education and future success Need an effective team –Faculty, staff, residents, institution (colleagues / legal)

7. Program Planning Build “Your Team” Organized and structured to regularly evaluate and provide feedback

8. Need Faculty Committment Your colleagues are critical to program development “Buy-in” and support Open lines of communication between all players (including the residents) –Honest and constructive evaluation and feedback

9. A B Medical Student Competent Orthopaedic Surgeon

10. A B Medical Student Competent Orthopaedic Surgeon

11. SETTING EXPECTATIONS

12. A B Medical Student Competent Orthopaedic Surgeon Start of residency Start of specific rotation Start of year in training Bogerd

13. Background Opportunity Goals Evaluation Rescue Deal

14. FREQUENT (and early) EVALUATION

15. A B Formative Evaluation Midrotation Formative Evaluation Summative Evaluation Bogerd Start of specific rotation in training

16. A B Formative Evaluation Midrotation Formative Evaluation Summative Evaluation Bogerd Start of specific rotation in training DOCUMENT

17. PROVIDING FEEDBACK

18. Pendleton Rules Bulstrode and Hunt (1997) –Adapted from Pendleton, a British marriage counselor Provides a method for providing feed-back –Formalizes the process –Makes the encounter non-threatening to the resident –Makes it less personal for the attending

19. Pendleton’s Rules 1)Teacher asks learner what went well from learner’s perspective 2)Teacher tells learner what went well from teacher’s perspective 3)Learner is asked what they could have done differently 4)Teacher provides input on what they believe could have been done differently

20. DOCUMENTATION

21. Documentation Document early and often Have scheduled evaluations for each service rotation –pre - mid - final Residency Director –Review all evaluations –Look for patterns, red flags –Biannual all faculty and chief resident review of all residents

22. Pitfalls Evaluation – “We don’t do it” –Tendency to be “supportive”, not objective Lack of documentation –“too little, too late” Lack of feedback to resident Lack of communication with other faculty –Is yours an isolated event (that you brush off) or a recurrent theme?

23. SUMMARY Start with Resident Selection Know your “Due Process” up front Build your team Set Expectations Frequent Evaluation Provide Feedback Honest Constructive Documentation!

24. THANK YOU