Situation: We are currently working on setting up a more formalized and structured remediation program for our residents to help handle academic and professionalism issues.

First, I would love to know what other programs do to help keep residents on task and meeting the requirements of their remediation contracts to try to avoid going on probation. For example, do they take away the resident’s ability to make schedule requests, are overnight shifts or weekends? I would prefer to utilize positive incentives to keep them on track, but I know that some will need to have negative consequences as a motivating factor.

Secondly, what other options for question banks are out there besides Rosh Review? I want to be able to assign questions, maybe even with certain topic focuses, and then be able to easily monitor their progress.  I know you can do some of this on Rosh but would love to know if there are other tools out there that might be better or to add in addition to Rosh.

Lastly, do you have any ideas on how to get residents to respond to emails or phone calls in a timely matter. Someone suggested having an email policy where they need to respond to an email in 24 hours however, how do you enforce something like this? 

Remediation Committee Assessment:

Thank you so much for reaching out to the Remediation Committee! Below is a summary of what we discussed during the Remediation Consult Session: 

1. Resident remediation requires an organized and goal-directed effort to be successful. Graduate medical education programs are responsible for ensuring that their graduates are competent across all domains of medical practice and remediation allows for the correction of deficiencies. Any resident who is placed on a remediation plan should have an in-person meeting with the program director as well as sign a remediation contract.  Within the remediation contract, there are several key elements:

• • A clear statement of the issue (“You are being placed on a remediation plan”)
  • The sources of information that prompted this decision
  • The timeframe of the remediation
  • The interventions that are to take place during the remediation
  • Clear documentation of the remediation supervisor (PD, APD, faculty coach etc)
  • The definition of successful completion of the remediation
  • The consequences for not meeting the goals of remediation (non-promotion, probation, non-renewal of contract, or termination
    
    The Remediation Committee has developed a standard Remediation Contract which will be available on the CORD website shortly. Residents should be informed that a probationary status will then be reported to all future employers. In our mind, that is the most important motivation for improvement! Short-term negative consequences such as extra weekend shifts and loss of the ability to make schedule requests may be short-term motivators but are less likely to affect long-term change. Another option in addition to punitive consequences is to consider is how a resident’s remediation can positively aid a program. For instance, a resident struggling with medical knowledge can be assigned to review ten core articles within the emergency medicine literature and then summarize the results to be posted on the residency website as a resource to other residents. 

2. In addition to Rosch Review, Hippo EM and Peer 9 are valued online question banks. One of the issues raised during the consult session was tracking a resident’s progress. Rosch review allows tracking resident progress from the PD dashboard but quizzes for particular subjects cannot be assigned. Another option is that if the program is buying the question banks for the benefit of the resident, you can have the resident set a generic password with their login that is accessible to residency leadership so that progress can be tracked. This should be disclosed with the participating residents. 
3. A policy related to the timely response of emails is a good idea. As not all emails have the same sense of urgency, it would be prudent to label those that need timely response as “urgent”. If a policy is in place, then failure to meet the policy may trigger professionalism remediation with the associated consequences. We also discussed the concept of “Mandatory Administrative Time” as a weekly session following education conference for those residents who consistently have difficulty with administrative tasks, such as responding to emails and procedure logging.