Promotion and Reappointment

Reappointment and promotion is contingent upon adequate clinical performance and non-cognitive performance in the present year and upon the expectations for performance at the next level of training. (Examples of non-cognitive performance include attitudes and humanistic qualities such as personal hygiene, timeliness, and ability to accept constructive criticism.) Satisfactory completion of all rotations in all areas of the evaluation process and ACGME categories is required. A promotion is based on satisfactory completion of the outlined curriculum, mastery of the clinical materials, and technical skills appropriate for the resident/fellow level. Residents will be expected to be in agreement with their ability to perform the technical and cognitive skills required as outlined in the “Essential Abilities” document and to notify the program director of requested accommodations, if applicable. See attached “Essential Abilities.”

Residents will be notified of non-reappointment by January 15 each year as per the institutional policy. Decisions to not offer reappointment are uncommon and usually follow written notification of inadequacies and opportunity to improve with the assistance and guidance of the department. Careful deliberation by the faculty and chair will precede any decisions to not reappoint a resident. Non-reappointments are handled in accordance with the policies outlined in the residency position appointment agreement.

Management of Problems

Evaluation of resident performance includes patient care, medical knowledge, practice-based learning, systems-based practice, interpersonal skills, and professionalism. Each of these areas requires continuous improvement, commitment, and self-monitoring. Notable incidents of concern or praise should be channeled to the program director and integrated into a composite assessment. Concerns may be transmitted to the program director by written evaluation, letters, phone conversation, or email. When the concern is not expressed in writing, the program director will make notes of the conversation.

When problems arise, the program director will assess the quality of performance over time, the presence of temporary life crises, the educational responsiveness of the resident, and the impact of the resident on the program. The program director may notify or request assistance for remediation from the faculty advisor, department chairperson, residency education committee, and/or entire faculty. Upon notification of a problem in cognitive or interpersonal performance, the program director will make an initial decision as to classification of a problem into one of three categories: minor concern, focus of concern, or academic probation. The resident will be made aware of the problem via a written statement clearly outlining the area(s) of deficiency and recommendations for improvement and will be given the opportunity to respond. The program director will notify the department chair as soon as possible of either focus of concern or probation status. In questionable cases of minor concern, and for all cases of focus of concern or probation, the problem will be discussed at the senior faculty meeting. The minimum level of response to any written complaint by a patient or any risk management issue will be focus of concern status.

A. Minor Concern:

Faculty are strongly encouraged to report any concerns (verbally or in writing), however minor, to the program director so that patterns of behavior can be recognized promptly. Such concerns should be discussed with the resident. The program director will make a written notation of any verbally reported concerns and the plan of action. At the discretion of the program director, the concern may be discussed with the program chair and senior faculty.

B. Focus of Concern:

Concerns may arise over clinical performance, following department policies/procedures, academic performance (see “academic guidelines”), documentation, interpersonal skills and attitudes, or other features that reflect negatively on the resident’s ability to carry out his/her duties. In making a resident a focus of concern, the department expects that the problem can be corrected immediately or in a defined period of time. The following written notice of deficiencies and corrective plan will be developed by the program director, faculty advisor, and training faculty:

  1. Elucidation and analysis of the problem
  2. Supportive and/or corrective intervention
  3. Monitoring mechanism including time until re-evaluation
  4. Consequences if corrective action not achieved

This focus of concern documentation will be given to the individual and will be made part of the file at the discretion of the program director. If the problem has been satisfactorily remedied at the time of re-evaluation, the focus of concern documentation may be removed from the individual's permanent file. A re-evaluation date will be established in the focus of concern documentation.

C. Probation:

Probation status may be designated due to deficits in a resident’s clinical performance, academic performance (see “academic guidelines”), failure to achieve focus of concern resolution, or a second incident during or following previous focus of concern status. In placing a resident on probation, the following written notice of deficiencies and corrective plan will be developed by the program director, faculty advisor, and training faculty:

  1. Elucidation and analysis of the problem
  2. Supportive and/or corrective intervention
  3. Monitoring mechanism including time until re-evaluation
  4. Consequences if corrective action not achieved

This documentation will become a part of the resident’s permanent file and may be disclosed to other agencies or persons when the physician seeks hospital privileges or licensure. Re-evaluation to remove probation status will occur at senior faculty meetings. Failure to achieve corrective action may result in extension of probation, non-renewal of appointment, or dismissal.

D. Dismissal:

Residents may be dismissed from the program for failure to meet program standards. Due process guidelines for termination for cause will be followed as outlined in the policies in the residency position appointment agreement. The basis for termination will be the evaluation of the professional performance and non-fulfillment of the conditions of appointment both to the training program and to the clinical sites to which the resident/fellow is assigned. Prior to termination, the resident will have a detailed meeting with the Program Chair and Program Director to discuss the specific deficiencies. The resident/fellow appointment may be terminated with 30 days written notice for cause by the Dean of the School of Medicine by action on, or acquiescence to, the recommendation of the Department Chair. These policies are standard for all accredited programs sponsored by the University of Washington School of Medicine.