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GME APPEALS POLICY – REVIEW AND CASE SCENARIOS LYDIA ESPINOZA, M. A. Sr. Director Graduate Medical Education Office TTUHSCEP NOVEMBER 30, 2018
OBJECTIVE • Review the GME Appeals Policy and go over case scenarios to understand the process in place
OUTLINE • Due Process • Adverse Action Appeals Policy
ACGME INSTITUTIONAL REQUIREMENT Institutional Requirements © 2018 Accreditation Council for Graduate Medical Education (ACGME)
RECOMMENDATIONS • Trainee Expectations • Early intervention • Make every possible effort to provide opportunity for improvement • Offer available resources
INFORMAL INTERVENTION • Verbal discussion • Performance Improvement Plan (PIP) • Reassessment Date
FORMAL INTERVENTION • Committee for disciplinary actions • The Clinical Competency Committee (CCC) serves as advisory • Legal Counsel
FORMAL INTERVENTION • Performance Deficiency Alert & Review (PDAR-1) Form http: //elpaso. ttuhsc. edu/som/gme/_documents/Disciplinary_Action_Notice_Performance_Deficiency _Alert_and_Review_Form 1. pdf • Performance Deficiency Alert & Review (PDAR-2) Form http: //elpaso. ttuhsc. edu/som/gme/_documents/disciplinary_action_notice_performance_and_deficie ncy_alert_and_review_form 2. pdf
FORMAL INTERVENTION • Trainee Notification • Review PDARs • Adverse Action
ADVERSE ACTION DEFINITION: • Actions taken by the training program as a consequence of underperformance (academic or behavioral)
DOCUMENTATION 1. 2. 3. 4. 5. Verbal conversations One-on-One Training Evaluations Special Accommodations Referral to the Resident’s Assistance Program (RAP) or other counseling 6. Test taking assistance 7. Performance Improvement and/or action plans
ADVERSE ACTION APPEALS POLICY
INSTITUTIONAL ADVERSE ACTION APPEALS POLICY http: //elpaso. ttuhsc. edu/som/gme/_documents/Adverse-Action-Appeals-Policy. pdf
APPEALABLE ACTIONS • Suspension • Non-Promotion (Repeat) • Non-Renewal • Dismissal
NON-APPEALABLE ACTIONS • Observation • Probation
APPEALS PROCESS 1. Institutional policy for appeals 2. Adverse action notification and copy of appeals policy 3. Program notifies GME office 4. Trainee appeals within the deadline 5. DIO establishes the Appeals Review Committee (ARC)
APPEALS PROCESS 6. Legal Counsel & witnesses submitted to ARC 7. Summary statements submitted to ARC 8. Hearing takes place 9. ARC prepares summary recommendation report to uphold or overturn 10. In Dismissal cases: • Final decision authority – Dean
CASE # 1 “The Case of the Traveling Card Jitters”
A resident trainee was provided an institutional State Travel Card for use when traveling to complete required rotations at out of town participating sites. The trainee misused the card on several occasions despite warnings.
WHICH OF THE FOLLOWING WAS THE FINAL ACTION TAKEN? • Suspension • Non-Promotion (repeat) • Non-Renewal • Dismissal
CASE DISCUSSION • Final Action taken: Dismissal • Is this action appealable?
CASE # 2 “A VERY BAD IDEA”
A resident was noticed by a colleague to smell of alcohol during clinic. His behavior was found to be erratic and was noticed by a nurse. This was reported by both the resident and the nurse to the program director.
WHICH OF THE FOLLOWING WAS THE FIRST ACTION TAKEN? • Suspension • Non-Promotion (repeat) • Non-Renewal • Dismissal
CASE DISCUSSION • First Action taken: Suspension • Is this action appealable?
CASE # 3 “A Case of the Examination Blues”
A PGY-2 resident trainee scheduled and took the USMLE Step 3 exam in April towards the end of the second year of training. The following month, the results came back indicating the trainee did not pass the exam.
WHICH ACTION WAS TAKEN BY THE PROGRAM? • Suspension • Non-Promotion (repeat) • Non-Renewal • Dismissal
CASE DISCUSSION • Action taken: Non-Renewal • Is this action appealable?
SUMMARY • Both faculty and trainees should be familiar with both the informal, formal intervention, and appeals process of underperforming residents. • It is important for programs to identify struggling medical learners early. • The Adverse Action Appeals policy offers the assurance for trainees to have a fair due process.
Thank you! Office of Graduate Medical Education (915) 215 -4460