Official disciplinary actions are probation and non-reappointment or termination. In some cases, a warning may be appropriate prior to an official action. The sequence is as follows:

Evaluation and feedback

The housestaff member is advised about deficiencies and the expectations for improvement clearly delineated. This should occur at every semi-annual evaluation, but also may occur in an interval meeting if needed. The ability to provide useful feedback is contingent upon regularly completed written evaluations of the trainee. The program director needs to provide clear guidance to the training faculty as to the types and frequencies of evaluations expected from them. Verbal feedback from a faculty member to the program director regarding a trainee, either positive or negative, should be followed up with a written communication for the trainee’s file.

Warning

When a trainee has been advised about deficiencies but fails to make sufficient improvement, he/she may be warned that continued lack of improvement may warrant probation. This information should be provided to the trainee in person and in writing.

Probation

Clearly suboptimal academic and/or clinical performance may warrant probation. The action should be explained to the housestaff member in person and in writing. Expectations for improvement, the methods for evaluating improvement, the anticipated duration of probation, and possible future actions should be delineated. The trainee should be advised that his/her academic file is always available for review and that he/she may appeal the decision. The trainee should be offered counseling. A template for a probationary letter is available in the GME office; please contact Dr. Sharon Dooley at sdo678@northwestern.edu

Non-reappointment/Termination

A trainee’s failure to remediate suboptimal academic and/or clinical performance may warrant a decision not to reappoint the trainee at the end of the current training year, or, in unusual circumstances, to terminate the contract immediately. The action should be explained to the housestaff member in person and in writing. As with a probationary letter, the trainee should be advised that his/her academic file is always available for review and that he/she may appeal the decision. The trainee should be offered counseling. A template for a non-reappointment or termination letter is available in the GME office; please contact Dr. Sharon Dooley at sdo678@northwestern.edu.

Termination without an intervening period of probation should be reserved for a serious deviation from acceptable academic and clinical performance, for example, dereliction of duty which endangers patient care

The Purpose of Disciplinary Actions

The objective of academic discipline is remediation. Thus, the terms of probation should always be carefully devised to ensure that the trainee has the opportunity to attain the desired improvement and that methods for evaluating that improvement are robust and as objective as possible.

Timing issues

A probationary period should be long enough to permit a thorough evaluation of progress. Except in unusual circumstances, a period of at least 3-4 months is required. The date on which the trainee’s status will be reconsidered should be picked in light of possible future actions, such as non-reappointment, so that ideally the trainee will have ample opportunity to find a different training program before the end of his/her training year. Alternatively, if a trainee’s lack of progress requires a period of probation late in the training year, there should be consideration of extending the current training year until a decision regarding adequacy of remediation can be made.

Applicable McGaw GME Policies and Procedures: Appeals

To appeal an adverse action, a housestaff member must submit a written notice of appeal to his or her program director within 14 days of receipt of written notification of the decision. The program director or department chair shall then request that the appropriate departmental committee review the housestaff member’s records and any correspondence submitted by the housestaff member subsequent to his or her notification of the decision. The committee will notify the housestaff member of the results of the appeal in writing within five days of completion of the review process.

If the initial adverse action is sustained by the housestaff’s specialty program, the housestaff member may appeal to the associate dean for graduate medical education. A written request for appeal must be submitted by the housestaff member within seven days of receipt of written notification that the adverse decision has been sustained. The associate deal shall review the housestaff member’s records and correspondence as well as the specialty program committee’s recommendations. The associate dean will interview the housestaff member and chair of the specialty program committee, as well as identify and interview faculty members responsible for the clinical supervision of the housestaff member. The associate dean will notify the housestaff member and program director of the determination in writing. This determination is final. If, in the opinion of the associate dean for graduated medical education, the housestaff member has not been provided access to his or her records, informed of deficiencies and provided an opportunity for their correction, afforded appropriate counseling, or afforded an appearance and provided written notice of action, he or she shall be restored to unconditional active status.

Applicable ACGME Policy

The ACGME Institutional Requirements specify that except in unusual circumstances, a decision not to reappoint should be conveyed in writing to the housestaff member by four months prior to the end of the current training year.

The Importance of Due Process

Following the appropriate policies and procedures for disciplinary action best ensures that, regardless of outcome, a trainee may feel that he/she has been treated fairly.