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Policy

Resident Assessment

Categories: assessment curriculum promotion PGME

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Purpose

To outline the principles and process of assessment, promotion, remediation, probation, suspension and dismissal of Residents.  

Principles

Assessment is based on the Residents’ attainment of specific objectives and competencies. Competencies are assessed over time, by multiple assessors and in multiple contexts.

Assessment includes identification and use of appropriate assessment tools tailored to specific CanMEDS competencies/ Triple-C Competency Based Curriculum within the training experience, with emphasis on direct observation, whenever possible.

Residents are expected to receive regular, timely and meaningful (narrative, actionable and concrete) feedback on their performance.

Assessment of Residents occurs in an open collegial atmosphere that supports and encourages active participation and self-reflection on the part of the Resident.

Assessment of Residents and the assessment documents are confidential. Access should be restricted to the Program Director, any individual or committee making promotion decisions, external certification and licensing bodies, and the Resident herself/himself.

Definitions

Academic Year typically commences July 1 and finishes June 30. On occasion a Resident may be out of phase at start or finish.

Academic Advisor (AA)/Faculty Advisor is a Faculty member who is responsible for coaching and guiding their assigned Resident(s) during their progression through residency training; including regular meetings with Resident(s) to conduct summative reviews of progress and facilitate creation and implementation of individualized learning plans, and reporting to the Competence Committee.

Assessment refers to the methods used to measure and document the competency, learning progress and skill acquisition of Residents throughout residency training.

Associate Dean, Postgraduate Medical Education (PGME) the senior Faculty officer responsible for overall conduct and supervision of Postgraduate Medical Education within the Faculty in the College of Medicine. The Associate Dean, PGME reports to the Vice-Dean, Medical Education.

CanMEDS/CanMEDS-Family Medicine framework defines characteristics of a competent physician around seven roles: Medical Expert/Family Medicine Expert, Communicator, Collaborator, Health Advocate, Scholar, Professional, and Leader.

Competence refers to the array of attributes across multiple domains or aspects of physician’s performance in a given context. It is dynamic, multi-dimensional and changes over time.

Competence Committee (CC) is a subcommittee of the Residency Program Committee which is responsible for assessing the progress of Residents in achieving the specialty-specific requirements of the program. It reports to the Residency Program Committee and monitors progress of each Resident, reviews and syntheses qualitative and quantitative assessment data at each stage of training.

Competence Continuum reflects the developmental stages of professional practice. Residency training in a specialty, as a part of Competence Continuum, is organized into four developmental stages: transition to discipline, foundations of discipline, core of discipline, and transition to practice. The outcomes of each stage are specialty specific.

Dismissal is the termination of the Resident’s appointment with the residency training program for academic or professional reasons.

Enhanced Learning Plan is an informal individualized learning plan intended to guide the Resident toward successful attainment of competencies.

Entrustable Professional Activity (EPA) is a key task of a discipline that an individual can be trusted to perform without direct supervision in a given health care context, once the individual has demonstrated sufficient competence, and typically integrates several milestones. 

Milestone is an observable marker of an individual’s ability along the Competence Continuum. 

Observer refers to the individual responsible for documenting their observations of a Resident’s performance conducting specific procedure, milestone or EPA. Observers are faculty members or other healthcare professionals, where appropriate.

Probation is a formal modification of residency training to address specific identified weaknesses and where the extent of those weaknesses is such that the Resident’s ability to continue training is, or is likely to be, significantly compromised. Probation is typically preceded by remediation.

Program is the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians Canada (CFPC) accredited residency training program at the College of Medicine.

Program Director is the Faculty member most responsible for the overall conduct of the residency program in a given discipline and responsible to the Head of the Department and to the Associate Dean, PGME in accordance with the criteria of the RCPSC/CFPC. Responsibilities of the Program Director can also apply to the responsibilities of the Site Director in CFPC programs, where appropriately delegated to the Site Director by the Program Director.

Postgraduate Medical Education (PGME) Office refers to the Associate Dean, PGME and the administrative personnel who are responsible for coordination and administration related to the oversight of the residency training programs.

Remediation is a period of targeted training with a Resident where the focus is on area(s) where the Resident is experiencing difficulties or is demonstrating lack of skills or knowledge, and where such difficulties are significant but potentially remediable.

Residency Program Committee (RPC; synonym Residency Training Committee) oversees the planning for the residency training program and overall operation of the program to ensure that all requirements as defined by the national certifying college are met; this includes selection of Residents, assessment and promotion of Residents, assessment of the rotational components/learning experiences of the program and individual clinical supervisors, program evaluation and curriculum development, and other tasks defined in the B 1.3 standard of the General Standards Applicable to All Residency Programs.   

Resident refers to postgraduate medical trainee enrolled in the RCPSC or the CFPC program.

Rotation (or learning experience) means the period of time a Resident is assigned to clinical or research service, for which there are specifically defined learning objectives. The duration of a rotation/learning experience is defined by the residency training program, and may be measured in blocks.

Triple C is a competency based curriculum for family medicine education that is comprehensive, focused on continuity of education and patient care, and centered in family medicine.

Scope of this Policy

This policy applies to Residents in competency based postgraduate medical residency training programs at the College of Medicine, University of Saskatchewan.

Policy

1)      Resident assessment

a)      Each residency training program will have a program-specific policy on programmatic assessment. 

b)      Assessment must be based on the goals and objectives of the program, and tools used must be compatible with the competency, skill, attitude or behaviour being assessed.

c)      Methods of assessment must be clearly communicated to the Residents and to the Faculty, and the level of performance expected of the resident in the achievement of program objectives must be clearly outlined.

d)      In RCPSC residency training programs, the milestones and EPAs to be completed within each stage of training and the number of observations expected for each EPA must be outlined and made known to Residents and Faculty. Residents shall be informed of the milestones and EPAs they are expected to accomplish within each rotation/learning experience by the residency program, with the understanding that the Competence Committee can alter the number of observations based on the performance of a Resident.

e)      There must be narrative, actionable, and timely feedback provided to each Resident. Feedback should be discussed with the Resident, preferably in person, and refine good practices and identify deficiencies.

f)        The Program Director is responsible for ensuring regular assessments of the Resident’s progress are occurring and are facilitated by the Resident. The Resident is responsible for ensuring an observer/preceptor is observing and documenting their performance in real time. The Resident is responsible for notifying their Program Director of circumstances that could affect their individual performance or the documentation of their performance.

g)      Program Director/Academic Advisor/Faculty Advisor will meet with the Resident at least quarterly to review progress in achieving the required competencies- quarterly academic review.

h)      The Competence Committee/RPC will meet (at least) twice during the academic year (preferably in December and June) to review progress in achieving the required competencies- biannual performance review.

i)        In RCPSC residency training programs, the Competence Committee can also meet at the request of the Resident, supported by the recommendation of the Academic Advisor, to decide whether to promote the Resident to the next stage of training.

j)        Residents will receive a global rating of ‘progress as expected’, ‘some concerns about progress’ or ‘significant concerns about progress’ after each quarterly academic review meeting and each biannual performance review meeting.

k)      Progress will be assessed based on all evidence contained in the Resident’s assessment portfolio. The assessment portfolio may include, but is not limited to: In-Training Assessment Reports (ITARs), In-Training Evaluation Reports (ITERs), other written assessments (essays, short answers, multiple choice), performance based assessments such as Objective Structures Clinical Examination (OSCE), Miniature Clinical Examination (mini-CEX), Simulated Office Oral (SOO), and 360⁰ assessments, chart reviews and formal observations of clinical or procedure skills, etc.

l)        A summary report of each meeting will be placed in the Resident’s portfolio after each quarterly academic review meeting, biannual performance review meeting, and stage review meeting.

2)      Progress in the Program and Promotion

a)      Progress and promotion decisions are made by the Competence Committee/Residency Program Committee, and will be based on all evidence available in the Resident’s assessment portfolio at the time of the progress/promotion meeting.

If there is not enough documentation to support a progress/promotion decision, the Resident will be notified in writing.

b)      The Resident will be promoted to the next stage of training if they have achieved all required training requirements for their current stage of training. The Resident will be advanced to the next PGY/FMR level if they receive global ratings of ‘progress as expected’ on two consecutive bi-annual performance reviews.

c)      If all competencies are not met, the Residency Program Committee, will direct the Resident to undertake specific goal-directed training to achieve the missing competencies.

d)      An RCPSC resident must successfully complete the Core of Discipline stage in order to sit the Royal College examination.

A CFPC Resident will be eligible to sit the certification examination if they have successfully completed 18 months of a 24-month postgraduate training.

e)      Completion of residency training and achievement of all competencies will be verified in the Resident’s final portfolio, which must be signed by the Program Director and the Associate Dean, PGME before it is submitted to the Royal College of Physicians and Surgeons of Canada/the College of Family Physicians of Canada.

3)      Enhanced Learning Plan

a)      An Enhanced Learning Plan (ELP) should be developed:

i)        to address repeated deficiencies noted in one or more competencies across several rotations/training experiences, whether or not the Resident receives global assessment of ‘progress as expected’; or

ii)      when the Resident receives one or more global assessment of ‘some concerns about progress’ on summative assessment of a rotation/learning experience, quarterly academic review(s) or bi-annual performance review(s); or

iii)    concerns exist about the Resident’s professional conduct in areas that are deemed rectifiable.

b)      An Enhanced Learning Plan will be developed by the Program Director.

c)      An Enhanced Learning Plan will specify learning objectives based on the identified deficiencies/concerns; competencies to be achieved; teaching and learning strategies for improvement and correction; assessment tools to be used to document performance; time-frames for assessment of successful completion; parameters for successful completion and consequences of less than satisfactory completion. 

d)      The Resident is expected to have a support of an Academic Advisor/Faculty Advisor/mentor for the duration of the plan.

e)      An Enhanced Learning Plan must be reviewed with the Resident and he/she must receive a copy of the plan. The Program Director/delegate and Resident must both sign the plan.

f)       It is expected that the concerns identified and addressed by an Enhanced Learning Plan can be resolved within subsequent rotation(s)/training experience(s) and typically will not increase the duration of training.

g)      The assessments from the Enhanced Learning Plan will be reviewed by the Competence Committee/Residency Program Committee to determine the outcome.

i)        The Enhanced Learning Plan will be considered as successfully completed when the Resident achieved all competencies expected and outlined in the plan; in which case the Resident will receive global assessment of ‘progress as expected’ and continue regular training program.

ii)      If some progress has been made during Enhanced Learning Plan, but it is not sufficient to correct all deficiencies/concerns identified, the Resident will receive global assessment ‘some concern about progress’, and will continue with the Enhanced Learning Plan (modified where necessary) for an additional period of time.

iii)    If the global assessment of the Enhanced Learning Plan is ‘significant concern about progress’, a Remediation plan must be developed. The Resident will meet with the Program Director to discuss the recommendations for remedial training.

4)      Remediation

a)      Remediation is required where ongoing deficiencies have been identified.

Triggers for Remediation include, but are not limited to, the following:

i)        The Resident received a global assessment of ‘significant concern about progress’ at the conclusion of a rotation/learning experience covered by an ELP;

ii)      two or more global assessments of ‘some concern about progress’ on summative assessment at the end of the rotation/training experience, quarterly academic review or biannual performance review;

iii)    one or more global assessments of ‘significant concern about progress’ on summative assessment at the end of the rotation/training experience, quarterly academic review or biannual performance review;

iv)    a newly recognized, serious problem in professional behaviour;

v)      an investigation into the circumstance which resulted in a Suspension and where it was determined that Remediation is required.

b)      A Resident can be placed on Remediation more than once during residency training, but may only be placed on Remediation one time in any academic year.

c)      The terms and conditions of the Remediation are developed by the Residency Program Committee in consultation with the Postgraduate Medical Education Office. The terms and conditions of the Remediation must be approved by the Associate Dean, PGME prior to the start of the Remediation.

d)      The terms and conditions of Remediation must be outlined in a written Remediation plan. The Remediation plan must include:

i)        Resident information;

ii)       timeframe (start date, projected end date, progress meetings);

iii)     reasons for Remediation (identified deficiencies requiring improvement/correction);

iv)     Remediation supervisor information;

v)       goals, objectives and competencies to be achieved to constitute a successful Remediation;

vi)     teaching and learning strategies for improvement and correction (tools and resources that will be used);

vii)   the assessment processes to be followed (assessment tools to be used to document performance, frequency and form of the meetings and feedback given to the Resident);

viii)  outcomes of Remediation;

ix)     record of approvals.

e)      The Resident on Remediation should (continue to) have the support of an Academic Advisor/Faculty Advisor/mentor for the duration of the Remediation.

f)       The Remediation must be reviewed with the Resident and he/she must receive a copy of the Remediation plan, prior to implementation. The Program Director/delegate and the Resident must sign the Remediation plan.

g)      The Resident will be advised of his/her right to appeal Remediation and the appeal process.

If the Resident chooses to appeal, the Resident will remain at the same training level while waiting for the outcome of appeal process, and promotion to another stage will be deferred. In exceptional circumstances (involving patient safety or other extraordinary situations), the Resident will be placed on a leave of absence while waiting for the outcome of the appeal process.

h)      The duration of the Remediation will be determined on a case-by-case basis, and will depend on the expected time for Resident to improve/correct deficiencies and/or duration of the failed rotation/learning experience.

Any single Remediation will not be for more than 6 months/blocks. The total duration of Remediation during entire residency in one program will not exceed 12 months/blocks.

i)        Remediation will require extension of training. Under exceptional circumstances, the Competence Committee/Residency Program Committee can recommend that the Remediation counts towards training required for credentialing and certification by the RCPSC/CFPC, if the Remediation has been successfully completed and all training requirements have been met.

j)        Any vacation or leave of absence request during Remediation must be approved in writing in advance by the Program Director. In the event that the Program Director determines that a leave of absence requested during the Remediation is appropriate, the Remediation will be considered incomplete, and might require modifications after the Resident’s return to training, taking into account the nature of the deficiencies identified, the performance of the Resident to date, and the need for continuity of clinical experience.

k)      The Resident cannot do electives or moonlight during the Remediation.

l)        In the event that it is determined that the Resident is not progressing during Remediation as anticipated, the Remediation plan may be re-evaluated. This re-evaluation will include reconsideration of the terms and conditions of the Remediation. Any modifications and extensions of Remediation must be approved by the Competence Committee/Residency Program Committee in consultation with the PGME Office.

m)   At the end of the Remediation, the Competence Committee/Residency Program Committee will review the Resident assessments to determine the outcome. 

i)            If the Resident receives global rating ‘progress as expected’, he/she will be deemed to have successfully completed the Remediation and will continue in the program at the level determined by the Competence Committee/Residency Program Committee.

ii)            If the Resident made progress, but not sufficient to correct all deficiencies/concerns identified, and the global rating of the Remediation is ‘some concerns about progress’, the Resident may receive an extension of Remediation (up until maximum period allowed) and additional support.

iii)            If the Resident receives a global rating ‘significant concerns about progress’, he/she will be deemed to have not successfully completed Remediation, and will be required to undergo Probation.

n)      All decisions regarding Remediation must be approved by the Associate Dean, PGME.

5)      Probation

a)      Probation is a formal academic standing that identifies a Resident as being at serious academic risk.

Triggers for Probation include the following:

i)        global rating of ‘significant concerns about progress’ after completion of Remediation;

ii)      Resident reaching maximum duration of a Remediation period;

iii)    Resident meeting the requirements for being placed on Remediation for the second time during an academic year;

iv)    two or more global assessments of ‘significant concern about progress’ on summative assessment at the end of the rotation/training experience, quarterly academic review or biannual performance review;

v)      an egregious or repetitive problem in professional behaviour, or a critical incident related to a lapse in professional behaviour;

vi)    a newly recognized, serious problem in clinical competency affecting patient care (egregious error),

vii)    an investigation into the circumstance which resulted in a Suspension and where it was determined that Probation is required.

b)      A Resident can be placed on Probation only once during the residency training program.

c)      The terms and conditions of the Probation are developed by the Residency Program Committee in consultation with the PGME office. The terms and conditions of the Probation must be approved by the Associate Dean, PGME prior to the start of the Probation.

d)      The terms and conditions of Probation must be outlined in a written Probation plan. The Probation plan must include:

i)        Resident information;

ii)      timeframe (start date, projected end date, progress meetings);

iii)    reasons for Probation (identified deficiencies requiring improvement/correction);

iv)    Probation supervisor information;

v)      goals, objectives and competencies to be achieved to constitute a successful completion of Probation;

vi)    teaching and learning strategies for improvement and correction (tools and resources that will be used);

vii)   the assessment processes to be followed (assessment tools to be used to document performance, frequency and form of the meetings and feedback given to the Resident);

viii)  outcomes of Probation;

ix)     record of approvals.

e)      The Resident on Probation should (continue to) have the support of an Academic Advisor/Faculty Advisor/mentor for the duration of the Probation.

f)       The Probation must be reviewed with the Resident and he/she must receive a copy of the plan, prior to implementation. The Program Director/delegate and the Resident must sign the Probation plan.

g)      The Resident will be advised of his/her right to appeal the Probation and the appeal process.

If the resident chooses to appeal, the Resident will remain at the same training level while waiting for the outcome of the appeal process, and promotion to another stage will be deferred. In exceptional circumstances (involving patient safety or other extraordinary situations), the Resident will be placed on a leave of absence while waiting for the outcome of the appeal process.

h)      The duration of the Probation will be determined on a case-by-case basis; in most cases it will not be less than 3 months/blocks and more than 6 months/blocks. The total duration of Probation will not exceed 12 months/blocks during entire residency, even if the Resident transfers from program to another program.

i)        The Probation will require extension of training (clearly outlined in the plan).

j)        Any vacation or leave of absence request during Probation must be approved in writing in advance by the Program Director. In the event that the Program Director determines that a leave of absence requested during the Probation is appropriate, the Probation will be considered incomplete, and might require modifications after Resident’s return to training, taking into account the nature of the deficiencies identified, the performance of the Resident to date, and the need for continuity of clinical experience.

k)      The Resident cannot do electives or moonlight during the Probation.

l)        At the end of the Probation, the Competence Committee/Residency Program Committee, will review the Resident assessments to determine the outcome.

i)            If the Resident receives global rating ‘progress as expected’, he/she will be deemed to have successfully completed the Probation and will continue in the program at the level determined by the Competence Committee/Residency Program Committee.

ii)            If the Resident made progress, but not sufficient to correct all deficiencies/concerns identified, and the global rating of the Probation is ‘some concerns about progress’, the Resident may receive an extension of Probation period and additional support (up until the maximum duration). If the Resident has exhausted the maximum duration of Probation period the Resident will be dismissed.

iii)            If the Resident receives global rating ‘significant concerns about progress’, he/she will be deemed to have not successfully completed Probation and will be dismissed as outlined in Section 8.

m)   All decisions regarding Probation must be approved by the Associate Dean, PGME.

n)      Any egregious or repetitive problem in professional behaviour, or a critical incident related to a lapse in professional behaviour as per (5(a)(v) may be reported to the College of Physicians and Surgeons of Saskatchewan (CPSS), in accordance with the CPSS policy.

In keeping with a CPSS policy (The 2004 Code of Ethics of the Canadian Medical Association, as adopted by the CPSS, para 48), “[a]void impugning the reputation of the colleagues for personal motive; however, report to the appropriate authority any unprofessional conduct by a colleague or concerns, based upon reasonable grounds, that a colleague is practicing medicine at a level below an accepted medical standard, or that a colleague’s ability to practice medicine competently is affected by a chemical dependency or disability”. CPSS has the authority to investigate concerns regarding the conduct and care provided by its members.

6)      Suspension

a)      A Resident may be suspended from their duties for any of the following reasons, which are viewed as critical event(s):

i)        where there are significant concerns about patient care and safety;

ii)      suspension of registration with the College of Physicians and Surgeons of Saskatchewan (CPSS);

iii)    loss of hospital privileges;

iv)    situations that call into question the ability of the Resident to maintain the integrity of the profession (e.g. criminal activity, inappropriate patient/physician interactions, etc.).

b)      A Program Director can recommend, after consultation with the Residency Program Committee, suspension to the Associate Dean, PGME, who will decide if a suspension is appropriate.

c)      Suspension decision will be communicated to the Resident verbally (in the meeting with the Program Director and the Associate Dean, PGME) in order to review the reasons and the events leading up to the Suspension of the Resident. This meeting will occur as soon as reasonably possible. The Resident may be accompanied by a colleague or other support person.

Following the meeting, the Suspension decision, including the information supporting such decision, will be communicated in writing (in the letter under the Associate Dean, PGME’s signature).

A copy of the decision will be sent to the College of Physicians and Surgeons of Saskatchewan (CPSS), in accordance with the CPSS policy.

d)      The Suspension will ordinarily be with pay pending an investigation.

7)      Investigation

a)      Investigation into an incident leading to a Suspension will be conducted as quickly as reasonably possible by the Investigation Committee (unless the incident is the suspension of license or loss of hospital privileges).  

The Investigation Committee will be chaired by the Department Head of the departmental home for the Resident’s training program. In extenuating circumstances, such as where there is direct involvement of the Department Head in the situation such that it would/ could create conflict of interest, a cognate Department Head may chair the Investigation Committee. The other members of the Investigation Committee will be:

i)        a representative of the Health Authority (designated by the Health Authority);

ii)       a representative of the CPSS (designated by the CPSS);  

iii)     a Resident representative (designated by the Resident Doctors of Saskatchewan);

iv)     a Faculty member from a cognate department with no involvement in the incident (appointed by the Department Head).

b)      In advance of a hearing, the Resident shall be fully advised in writing of the allegations or complaints and information to be reviewed by the Investigation Committee and of the procedure which the Committee intends to follow.

c)      The Resident must have an opportunity to respond to all allegations under consideration and will be invited to participate at the meeting of the Investigation Committee. The Resident may be accompanied by a support person or legal counsel (in which case the Resident must advise in writing of the presence of the legal counsel prior to the scheduling of the meeting) at the meeting.

d)      All information provided to the Investigation Committee by either party, will be shared with both the Resident and respondent.

e)      The Investigation Committee, after considering the matter, shall render a written recommendation to the Associate Dean, PGME outlining in detail the concerns and the rationale for the decision.

The Investigation Committee may recommend:

i)        full reinstatement into the program;

ii)      reinstatement with conditions; or

iii)    dismissal from the program.

j)        The Associate Dean, after discussions with the Dean, College of Medicine, will inform the Resident and the program of the decision.

A copy of the decision, including the information which supports such decision, will be sent to CPSS.

8)      Dismissal

a)      A Resident may be Dismissed from the residency training program for:

i)        the failure of Probation;

ii)      for being recommended for Probation twice during the residency training;

iii)    for unethical or unprofessional conduct following the recommendation from an Investigation Committee;

iv)    situations related to the requirements for professional practice as described in standards of the credentialing and licensing bodies.

b)      The Residency Program Committee may make a recommendation regarding Dismissal of a Resident.

c)      The Resident must be advised by the Program Director, in writing, of the Recommendation to Dismiss him/her from the program and the reasons for this decision. A copy of the letter with the Recommendation to Dismiss must be sent to the Associate Dean, PGME.

d)      In all cases, the Resident must be aware of, and have an opportunity to review all material that is considered in making a decision for Dismissal. The sources of all material must be identified and Resident must have an opportunity to respond to such material.

e)      The final authority for Dismissal rests with the Dean of the College of Medicine, who may delegate it to the Associate Dean, PGME. 

f)       The Dean of the College of Medicine, or the Associate Dean, PGME will inform the Resident in writing of a decision for Dismissal. The Dismissal letter given to the Resident (signed by the Dean, College of Medicine or the Associate Dean, PGME) will include the reasons and the termination date.

g)      The Resident will be advised in writing of his/her right to appeal the Dismissal and the appeal process.

Responsibilities

It is the responsibility of the residency training program to have written goals, objectives and competencies each Resident is required to attain at each stage of training, and on which the assessment process and progress in the program is based. Resident must be provided with these upon entering the program or when starting a different stage within the program.

Residents have the responsibility to familiarize themselves with the rules and processes governing assessment and promotion.

It is the responsibility of a Resident with a disability to request accommodation of a disability in a timely manner, if he or she feels that their performance in the program is or might be adversely affected by their disability.  

Non-compliance

Instances or concerns of non-compliance with this policy should be brought to the attention of the Associate Dean, Postgraduate Medical Education.

Contact

Coordinator, Academic and Non-academic Processes, PGME Office

Phone: 306-966-6145