Resident in Difficulty

Optimally, residents in academic difficulty are identified through discussion and feedback that is documented and shared.  This may come from a variety of sources; preceptors, faculty, and administrators.  Residents should be informed early on if there are concerns about their performance.   

Documentation is important. Preceptors are encouraged to "flag" their concerns, after discussion with the Resident, on the In-Training Assessment Report, and provide ample narrative descriptions.  

The In-Training Assessment Report is available for the Resident to read.  Residents are strongly encouraged to review each of their In Training Assessment Report as it is completed, through the One45 WebEval System.  Ideally, residents would be aware of concerns based on a discussion with their Preceptor or Site Director, and not be "surprised".   

The Competency Committee reviews the assessment information and using the  CFPC's Assessment Objectives' 6 Essential Skill Dimensions, creates an "educational diagnosis" for any resident in difficulty.   The Priority Topics in the Assessment Objectives provide situation-specific performance targets (key features) for competence by the end of training.  The CanMEDS-FM roles are likewise used to define an "educational diagnosis" for challenges in any of the 7 roles.

Professionalism is a unique concern as expectations of professional behaviour are mandated by the University of British Columbia Faculty of Medicine, by the College of Physicians and Surgeons of British Columbia, and by the Family Medicine Residency Program.  Professionalism is expected in all public domains, not just the clinical context.  These domains include the educational context of the program.  By this, we mean all the tasks, duties, and responsibilities related to being part of the program.  For example; ensuring that appropriate educational licensure is maintained, and those important communications are responded to in a timely fashion.

Progress is discussed in the Periodic Review.  Residents are asked to reflect on their progress and interpret their assessment information with their competency coach. Concerns are often initially raised at the Periodic Review.  At some sites, the Site Level Competency Committees may precede the Periodic Review, and concerns are brought up at this meeting first. 

Concerns, particularly flags from an In-Training Assessment Report, are discussed at the Site Level Competency Committee, where an educational diagnosis and recommendations are created. At Some sites, the recommendations go to the Site Director for discussion at the Periodic Review. 

If the situation requires rapid intervention, a Site Director can, in consultation with at least one other faculty member, initiate a discussion with the Performance Support Team or Program Director and subsequently bring the concern and actions taken to the next Site Level Competency Committee for review.

A phone call directly to the Program Director is required for the following circumstances:

Site Directors are encouraged to call the Performance Support Team at any time for consultation.  Consultation does not necessarily result in a referral to the Program Competency Committee. 

The Performance Support Team determines the need for referral to the Program Competency Committee.

Formal referral to the Performance Support Team by the Site Level Competency Committee is required for the following circumstances.

Any Resident discussed at the  Program Competency Committee, must be informed, in advance of this discussion by the Site Director.  

The Program Competency Committee makes decisions on Residents who are in academic difficulty and receives and reviews all cases of significant difficulty with Professionalism.

The Program Competency Committee may act as a consultant group for any Site Director or the Performance Support Team  related to a resident in difficulty, and is empowered to make the following decisions:

1. Need for a Focused Learning Plan (Note that the Site Level Competency Committee may also institute a Focused Learning Plan, and must review by four months to determine if success has been met.)
2. Need for Formal Remediation
3. Progress and success on Remediation and any Focused Learning Plan initiated by the Program Competency Committee.
4. Need for Administrative Leave, (the Program mandating that a Resident take a leave)
5. Program extension secondary to Formal Remediation
6. Advancement - R1/R2 for any Resident who has been discussed and is on Formal Remediation.   For any resident on a Focused Learning Plan instituted by the Program Competency Committee, this advancement decision may be made by the Program Competency Committee or devolved to the Site Level Competency Committee. 
7. Referral to the Postgraduate Faculty of Medicine, in cases of complex or protracted Formal Remediation or potential for a recommendation of dismissal.

Potential recommendations by the PCC include and are not limited to:

• Focused Learning Plan
• Formal Remediation
• Extension of Remediation
• Extension of Program
• Attention to any medical condition that appears to impede resident performance
• Coaches & Tutors Program
• Administrative Leave
• Dismissal (Recommendations for consideration of dismissal must be referred to the Faculty of Medicine's Oversight Committee.)
• Reduction of workload (part-time) to allow for directed study

Following a discussion of a Resident's performance at the Program Competency Committee, each Resident discussed will receive a memo outlining the concerns, and recommendations of the Committee.  Copies of this memo are sent to the Site Director, Program Director, Director of Performance, and the Chair of the Site Level Competency Committee.  

Residents are invited to submit relevant information to the Program Competency Committee. 

Support available for residents in difficulty includes:

• Resident Wellness Office
• Center for Accessibility
• Site faculty for Wellness at many sites (in a non-evaluative role)
• Coaches & Tutors Program
• Team-Based Primary Care Learning Centres
• Physician Support Program

The Family Medicine Residency program has Family Physicians that can act as a coach or bedside tutors to assist residents in difficulty.  

There are 16 Team-Based Primary Care Learning Clinics in British Columbia.  These Clinics can provide a supportive educational environment with additional time for coaching and assessment for residents in academic difficulty.  

If the resident is on a Focused Learning Plan (FLP) or Remediation, you should be informed of this by the resident.  Both of these are written plans.  If you are the primary preceptor, this written (Focused Learning Plan, or Remediation Plan) should be shared with you by the resident.  This way you are able to direct your comments to the learning goals articulated in the  Focused Learning Plan or Remediation Plan. Your input, when a resident is in difficulty is critical to the Competency Committee's determination of success for this resident. 

Preceptors are supported broadly by the site's Faculty Development faculty member.  Ideally, for any resident on a Focused Learning Plan or Remediation Plan, the plan would be shared with the preceptor and include contact information for the Site's Faculty Development faculty.   The Performance Support Team is available to preceptors for ongoing support.  

The Program and Regulatory Bodies require that Physicians, including those in training, are professional at all times.  This includes when in the public eye, whether in a clinical setting, in the Site Office, or in the parking lot at the Hospital.  Professional composure and behaviour are important.  Professionalism is complex and the Assessment Objectives Professionalism Skills give a rich picture of what is expected in the clinical, academic, and educational settings.  The UBC Professionalism Standards and  CPSBC Code of Professionalism guide physician behaviour at all times. 

Egregious Professionalism issues are dealt with by the Program Director and the Postgraduate Medical Education Deanery.  As well, information flows to the Program Competency Committee for review.

The Program Competency Committee chair will mandate an Assessment Summary and review of the narrative to identify concerns that were not formally flagged.  Should none exist, the file will be closed.

Should professionalism concerns that had not been formally identified be noted, the "in-program" concerns will be discussed by the PCC and recommendations made to the Program Director and Director of Performance.