Setting a Good Foundation
It is our responsibility to provide high quality education through well-planned learning experiences with clear expectations to all our trainees. We typically think about these issues at accreditation, but program organization also impacts remediation. In the event of performance problems, a solid program structure facilitates identification and description of the problem, which is the first step toward improvement. A corollary is that, in the absence of a solid program structure, trainees may rightfully argue that the reason for apparent gaps is a lack of clarity, quality or relevance of the expectations. Failing that, they may claim a lack of access or awareness.
- Clear expectations for performance at all relevant stages of training (rotation, PGY level, EPA), that are easily accessed by trainees
- A curriculum map or plan that links to all of the requirements set out in your RCPSC or CFPC training
- An assessment plan that is readily available to residents, and that clearly identifies all of the sources of assessment that will be used in decisions about progress, remediation, probation or dismissal. For any given assessment tool (OSCE, MCQ, STACER, etc) it must be clear whether it can constitute sole ground for remediation or will it be used in conjunction with other information to support a decision.
- A process to ensure that feedback is timely, useful AND demonstrable that includes;
- ALL of the assessments indicated in the Assessment Policy
- A high compliance rate within the prescribed time frames
- Clear documentation
- Clear communication to the Program Director (PD) when trouble arises
Averting the Impending Remediation
The best remediation is one that never happens. With good assessment practices, it is usually apparent that a resident is struggling prior to a formal remediation trigger actually happening. This time is a window of opportunity to discuss with the trainee and implement a Modified Learning Plan that might get them back on track prior to ever needing remediation. This is obviously better for the trainee, and easier to implement than a formal remediation. Even if a MLP is unsuccessful and formal remediation ensues anyway, one can at least feel reassured that this outcome was unavoidable and not simply due to inattention by the program.
Getting Ready for Remediation
Timelines are very tight, and for good reason. Once a problem has been identified, the lag time between the first identification and action is problematic. The path to success is to remain ahead of the problem. There are different ways that problems may be brought to light, but with rare exceptions, it is known well in advance of the formal trigger event. At the first hint of trouble, even if informal, you should begin your planning;
- Download and review the Remediation Agreement
- Is the problem documented- MRA’s accurate and timely, discussed with trainee?
- What is the problem and what kind of modified learning plan is applicable
Consult the Construct Section for ideas on suitable interventions
- Start writing up a Remediation Agreement now
- On the last day of the rotation (or the day of the trigger) sit down with the trainee with the Agreement in hand
- Document the meeting (minutes)
- Send the completed Agreement (including signatures) immediately to the Associate Dean - PGME and CESaR Chair via email@example.com
Creating a Plan
Subsequent sections of this website go into the steps in creating a good remediation in more detail. You will want to give thought to the general structure, timing and environment for the remediation. You will then need to add a Modified Learning Plan, which provides specific additional resources to the trainee. The important guiding principle is that the purpose of remediation is to return the trainee to the expected trajectory. A clear description of the problem(s) is a crucial and often neglected first step. Resources that are likely to help usually follow from that. Simply repeating the rotation is typically not an effective plan. On the other hand, it is also not necessary to use every possible intervention for every issue. You should ask yourself whether this plan is likely to make the candidate successful.
The timelines for processing Remediations and Probations are very tight. The coexistence of CFPC/CCC, and RCPSC CBD and Time-Based programs all under PGME creates a confusing landscape of timelines for different circumstances. Your first step should be to consult the governing Assessment Policy for your situation. The following tables provide a summary of the Program timelines for ease of reference;
**Table coming soon!