Promoting Professionalism through Remediation in Residency Education (Presented at ICRE 2016 Niagara Falls Top Five Session - What Works)

Promoting Professionalism through Remediation in Residency Education (Presented at ICRE 2016 Niagara Falls Top Five Session - What Works) Introduction: The Professional Role in the CanMEDS 2015 Physician Competency Framework underscores physicians’ accountability to society and the privilege of physician-led regulation. Addressing unprofessional behaviors among residents promotes professionalism if remediation is embedded within the two communities of practice interacting in the academic health centers: the clinical workplace and the educational space (Kalet & Chou, 2014). We developed a strategy to address unprofessional behaviors with residents in order to achieve effective remediation to maximize healthcare and educational outcomes. Method: We implemented a 4-level strategy adapting the approach by Hickson et al (2007) to address unprofessional behaviors and a remediation process for the “difficult trainee” who typically presents with behavioral problems as “personal conduct that negatively affects or potentially affects patient care” (Kalet & Chou, 2014). Level 0 “Informal Intervention” was a dialogue between the resident and the clinical tutor or chief resident; Level 1 “Professionalism Awareness” was a formal intervention by the program director (PD); Level 2 “Leadership Intervention” was a formal intervention by the PD, medical residency programs director (MRPD) and professionalism director; and Level 3 “Disciplinary Action” was a formal intervention by the Dean of GME, MRPD, PD, professionalism director and the Dean of Students Affairs. Results: The implemented strategy during 2015 with 6 residents’ cases included clear communication and documentation, enabling remediation and disciplinary action when indicated. Conclusions: It is necessary a model for faculty development to support remediation and residents’ professionalism education with the understanding that physicians are accountable to society, to their profession, and to themselves.