Association of Vascular Surgery Coordinators

Dealing With

Problem Residents

Peter J. Pappas, M.D.Professor of Surgery

Program Director: New Jersey Medical School Vascular Surgery Residency

Qualifications

• Vascular Surgery Program Director for 10 years.– Traditional 5 + 2 training program

• General Surgery Program Director for 4 years– Second largest residency program in

country– 86 categorical, non-designated and

designated preliminary residents– One to two problem residents in each PGY-

year per year.

Definition of a “Problem” Resident

• Academic Issues– Failure to progress

• Poor knowledge acquisition, poor clinical judgement, patient safety issues and so on.

– Learning Disabilities• AADD• Dyslexia

– Substance Abuse• Alcoholism• Drug Dependence

• Non-Academic Issues– Sexual Harassment– Racial Discrimination– Residency verification

for Hospital priviledging

• What do you report if the above occurred?

CIR 2009-2010 Contract

GrievanceAnd

DisciplinaryProcedures

Identification of Specific Issue

• First line of defense is the rotation evaluations– Rotation evaluations will often be first notification

of a potential problem.

– Monthly/Bi-monthly residency review committee is crucial

• Oral discussions reveal issues not documented in rotation evaluations.

• Documentation of the oral discussions in the semi-annual evaluation is crucial especially if items not documented in rotation evaluations are discussed.

Residency Review Committee Meetings

• Avoid personality discussions.

• Use competencies to identify, dissect and specify exact academic issue.

• Develop uniform set of phrases that explain the deficiency identified.

• Use these phrases in semi-annual evaluation. They will serve as the basis for a remediation plan if necessary.

Competency Deficiency Phrases

• Knowledge Base

– Poor fund of textbook knowledge for current PGY level.

– Poor textbook knowledge base foundation.

• Clinical Judgement

– Inability to translate textbook knowledge into clinical decision making.

Competency Deficiency Phrases

• Oral presentations

– Inability to present pertinent data in a succinct manner during walk rounds.

– Demonstrates disorganized and illogical thought processes during formal oral and written presentations.