Program Director Corner – October 2017
Richard Auchus, MD
Program Director & Professor
University of Michigan
rauchus@med.umich.edu
Remediation
The last thing in the world we want to do as PD’s is to inform a fellow about poor performance. Rather than avoiding the confrontation, it is our job to nip the problem in the bud, and the sooner we act the better the outcome. I have found that most of the time the issue is professionalism, which is a challenge to instill in Millennials; however, poor knowledge and skills can also require attention. Here are some tips, which I have gathered from our Internal Medicine Core Program Director and from our other fellowship PD’s at my institution.
1. Gather specific facts. Vague criticisms go nowhere. “On Oct 3, you failed to respond to a page about a clinic patient with a glucose of 420.” You might have to prod faculty members to get specific.
2. Put it in writing. When you call the fellow on the carpet, you should have a letter written that lists your concerns, the facts supporting the concerns, and your plan for remediation and the consequences of failing to meet the milestones of the plan.
3. Develop a specific plan. You are not calling the meeting to complain but to help get them on track. Identify one or two faculty member who will work with them closely. If knowledge is the problem, give them reading material. If delinquent notes, give them deadlines. Maybe they need a lighter clinic load for a few weeks to catch up. Give them a timeline and deliverables.
4. Is something else wrong? Depression is rampant among postgraduate trainees. Some fellows hide their personal problems, which interferes with their performance. Offer to get help, which most departments provide. If there are family problems, maybe a short leave of absence is in order. Of course, there are some questions we cannot ask nowadays, but an open-ended question is politically correct. “You seem down recently, is there something I can help with?”
5. Have the fellow sign the letter. The signature attests that the meeting occurred.
6. Document, document, document. After the meeting occurs, note to file what took place. Note to file every 4-6 weeks on the progress, not the Magna Carta but just a few lines: “Fellow X has read 2 chapters in Williams and now answers questions on thyroid testing correctly and with confidence.” You can just email the Program Coordinator, who can print a pdf and file it away.
7. Let fellow know when you are satisfied. After the remediation period of 3-6 months, there are 3 possible outcomes: back on track, continue remediation, or failure.
I would invite your feedback and your own experience on the topic.
So who is next? I have some ideas for topics for future Program Director Corner articles:
-Faculty Development
-Running an Annual Program Review Meeting
-Service vs. Education
-Transition to Milestones
-Dealing with Problem Faculty
Email apdem@endocrine.org if you are interested in contributing to next month’s Program Director Corner with your own article.