Weizberg Moshe, Smith Jessica L, Murano Tiffany, Silverberg Mark, Santen Sally A
Staten Island University Hospital, New York, NY.
Acad Emerg Med. 2015 Jan;22(1):113-6. doi: 10.1111/acem.12559.
Emergency medicine (EM) residency program directors (PDs) nationwide place residents on remediation and probation. However, the Accreditation Council for Graduate Medical Education and the EM PDs have not defined these terms, and individual institutions must set guidelines defining a change in resident status from good standing to remediation or probation. The primary objective of this study was to determine if EM PDs follow a common process to guide actions when residents are placed on remediation and probation.
An anonymous electronic survey was distributed to EM PDs via e-mail using SurveyMonkey to determine the current practice followed after residents are placed on remediation or probation. The survey queried four designations: informal remediation, formal remediation, informal probation, and formal probation. These designations were compared for deficits in the domains of medical knowledge (MK) and non-MK remediation. The survey asked what process for designation exists and what actions are triggered, specifically if documentation is placed in a resident's file, if the graduate medical education (GME) office is notified, if faculty are informed, or if resident privileges are limited. Descriptive data are reported.
Eighty-one of 160 PDs responded. An official policy on remediation and/or probation was reported by 41 (50.6%) programs. The status of informal remediation is used by 73 (90.1%), 80 (98.8%) have formal remediation, 40 (49.4%) have informal probation, and 79 (97.5%) have formal probation. There was great variation among PDs in the management and definition of remediation and probation. Between 81 and 86% of programs place an official letter into the resident's file regarding formal remediation and probation. However, only about 50% notify the GME office when a resident is placed on formal remediation. There were no statistical differences between MK and non-MK remediation practices.
There is significant variation among EM programs regarding the process of remediation and probation. The definition of these terms and the actions triggered are variable across programs. Based on these findings, suggestions toward a standardized approach for remediation and probation in GME programs are provided.
全国急诊医学（EM）住院医师培训项目主任会让住院医师接受辅导和留用察看。然而，毕业后医学教育认证委员会和急诊医学项目主任尚未对这些术语进行定义，各机构必须制定指导方针，界定住院医师从良好状态转变为接受辅导或留用察看的标准。本研究的主要目的是确定急诊医学项目主任在住院医师接受辅导和留用察看时，是否遵循共同的流程来指导行动。
通过SurveyMonkey以电子邮件形式向急诊医学项目主任发放匿名电子调查问卷，以确定住院医师接受辅导或留用察看后的现行做法。该调查询问了四个类别：非正式辅导、正式辅导、非正式留用察看和正式留用察看。对这些类别在医学知识（MK）和非MK辅导领域的不足进行了比较。调查询问了存在何种指定流程以及会引发哪些行动，具体包括是否会在住院医师档案中存档文件、是否会通知毕业后医学教育（GME）办公室、是否会告知教员，或者是否会限制住院医师的特权。报告了描述性数据。
160名项目主任中有81人回复。41个（50.6%）项目报告了关于辅导和/或留用察看的官方政策。73个（90.1%）使用非正式辅导状态，80个（98.8%）有正式辅导，40个（49.4%）有非正式留用察看，79个（97.5%）有正式留用察看。项目主任在辅导和留用察看的管理及定义方面存在很大差异。81%至86%的项目会就正式辅导和留用察看在住院医师档案中放入官方信函。然而，只有约50%的项目在住院医师接受正式辅导时通知GME办公室。MK和非MK辅导做法之间没有统计学差异。
急诊医学项目在辅导和留用察看流程方面存在显著差异。这些术语的定义以及引发的行动在不同项目中各不相同。基于这些发现，针对毕业后医学教育项目中辅导和留用察看的标准化方法提出了建议。
