Murano Tiffany, Kunac Anastasia, Kothari Neil, Hillen Machteld
Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, USA.
Surgery, Rutgers University New Jersey Medical School, Newark, USA.
Cureus. 2023 Mar 6;15(3):e35842. doi: 10.7759/cureus.35842. eCollection 2023 Mar.
Purpose Remediation is a daunting process for both residency leadership and trainees due to several factors including limited time and resources, variable processes, and negative stigma. Our objective was to transform the remediation process by creating a transparent institution-wide program that collates tools/resources, interdepartmental faculty mentors, and positive rebranding. Methods Education leadership across seven specialties created a process for trainees with professionalism and interpersonal-communication skills deficiencies. Formalized departmental program-based improvement plan (PIP) and an institutional house staff performance enhancement plan (HPEP) were developed by consensus of triggers/behaviors. Utilizing published literature, a toolkit was created and implemented. Trainees were enrolled in HPEP if PIP was unsuccessful or exhibited ≥1 major trigger. Wellness evaluations were incorporated into the process to screen for external contributing factors. Surveys were sent to the program director (PD), faculty mentor, and trainee one month and six months after participation. Results Between 2018 and 2021, 12 trainees were enrolled. Overall feedback from PDs and the trainees was positive. The main challenge was finding mutual time for the faculty mentor and trainee to meet. Six-month surveys reported no relapses in unprofessionalism. One-year follow-up of the trainees was limited. Conclusions Utilizing an institution-wide standardized process of performance improvement with the removal of negative stereotyping is a unique approach to remediation. Initial feedback is promising, and future outcome data are necessary to assess the utility. The HPEP may be adopted by other academic institutions and may shift the attitudes about remediation and allow trainees to see the process as an opportunity for professional growth.
目的 由于包括时间和资源有限、流程多变以及负面 stigma 等多种因素，补救对于住院医师培训项目负责人和学员来说都是一个艰巨的过程。我们的目标是通过创建一个透明的全机构项目来改变补救过程，该项目整合工具/资源、跨部门教师导师以及积极的重新品牌化。方法 七个专业的教育负责人为专业精神和人际沟通技能存在缺陷的学员创建了一个流程。基于触发因素/行为的共识，制定了正式的基于部门项目的改进计划（PIP）和机构住院医师绩效提升计划（HPEP）。利用已发表的文献，创建并实施了一个工具包。如果 PIP 未成功或出现≥1 个主要触发因素，学员将被纳入 HPEP。健康评估被纳入该过程以筛查外部促成因素。在参与后的 1 个月和 6 个月向项目主任（PD）、教师导师和学员发送了调查问卷。结果 在 2018 年至 2021 年期间，有 12 名学员被纳入。PD 和学员的总体反馈是积极的。主要挑战是找到教师导师和学员相互见面的时间。6 个月的调查显示没有出现不专业行为的复发情况。对学员的 1 年随访有限。结论 利用全机构标准化的绩效改进流程并消除负面刻板印象是一种独特的补救方法。初步反馈很有希望，但需要未来的结果数据来评估其效用。HPEP 可能会被其他学术机构采用，并可能改变对补救的态度，让学员将这个过程视为职业成长的机会。
