Quick Questions

What is the difference between Learning Support, Remediation, and Probation?

Support Document - Learning Support Plan OR Remediation? 

Learning support, Remediation, and Probation are educational interventions that are intended to support the resident in getting back on track and addressing identified areas of concern. There are important differences between them.

Learning Support is an informal, early intervention mechanism in which concerns that have been identified are addressed within the context of a regular rotation. This can be done through extra work assigned, additional meetings, reflections, or essays, etc. A learning plan is compiled in collaboration with the learner or the learner can develop their own learning plan. A learning support plan is generally created on a per rotation basis and the activities can be completed reasonably within the time of a rotation.

Remediation is an intervention that is implemented when there is a recurrent pattern of identified performance deficits despite feedback and early attempts to correct the concern. This is a formal period of intervention in which a rotation will often be modified to allow for additional learning activities. Remediation lasts for up to 12 weeks. A Remediation Plan is developed in collaboration with the PGME Education and Learning Resource Specialist, the Director of Learner Resources, and is approved by the RTC as well as the Associate Dean, PGME.

Probation is considered when Remediation has not been successful at rectifying deficiencies. It is a formal period of intensive assessment in specific critical skills and/or behaviors, with an increased frequency of assessments and use of diverse assessment tools. It is a time for the learner to demonstrate their ability to perform at expected level and demonstrate their proficiency in critical areas. The consequence of unsuccessful Probation is dismissal.

For more information, review the Guidance notes for Learning Support, Remediation, and Probation.

When should I consider a Learning Support Plan?

Learning Support is an early intervention mechanism that should be initiated when a weakness is identified. A learner can also, themselves, take initiative to address deficits by asking for assistance and devising a plan. A Program Director can initiate the learning support process and work with the resident and subsequent preceptor(s) to devise an individualized learning plan within the regular context of the program. The PGME Education and Learner Resource Specialist can be solicited to aid in this process but no formal PGME approval is required.

When should a resident be considered for Remediation?

The decision regarding remediation is made by the Residency Training Committee (RTC) or Residency Program Committee (RPC) based on supporting evidence demonstrating a pattern of concerns. There are several reasons when remediation must be considered when:

• the learner has failed a rotation
• the learner has had multiple borderline evaluations or there is a pattern of borderline elements within their evaluations across multiple rotations
• the learner has been on a Learning Support Plan before and the same concerns persist despite feedback and learning support
• there have been multiple concerns expressed by faculty and/or staff and documented on evaluations
• there are serious or repeated professionalism concerns
• there is a serious patient safety concern (near-misses or a critical incident)
• the Competence Committee has determined that a resident is not progressing as expected
• the Competence Committee has determined that there is a lack of Assessment data in support of competence

Please refer to the Resident Remediation, Probation & Dismissal Policy  for more detailed guidance as well as the supplemental Guidelines.

What if the resident refuses the Remediation process?

A resident has the right to appeal a rotation ITER that is overall “failed” or “unsatisfactory”. A resident may not appeal a decision that Remediation is required.  The resident must comply with Remediation. A failure to comply with Remediation is grounds for dismissal.

It is helpful to connect the resident with all resources available so they have opportunities to discuss their concerns with someone other than their PD. These resources include:

• Mentor: This can be a person previously assigned by the Program or chosen by the resident who is not directly involved in their evaluation process and with whom the resident is comfortable discussing career trajectory.
• Ombudsman: Each Program has an associated ombudsman who is available to meet with residents and review confidential concerns. The list of ombudsman is found here: PGME - Residency Program Ombuds | Cumming School of Medicine | University of Calgary (ucalgary.ca)
• Directors of Resident Support: Individuals through PGME who meet with residents and discuss confidential concerns (pgme.drs@ucalgary.ca)
• Wellness Office: The Office of Resident Affairs and Physician Wellness is available for residents who need to reach out for resources on coping with challenging situations.

Please refer to the Resident Appeals Policy for further information and process guidance, as well as the Resident Remediation, Probation, and Dismissal policy.

What do I schedule for the resident while putting a remediation plan together?

A remediation plan can take 2 - 4 weeks to organize. A resident can stay on rotation if there is a rotation that they can safely participate in and that does not put the resident at risk of failing another rotation. This time is often considered “unassessed” such that the resident still receives constructive feedback but the evaluations on this rotation do not count towards formal assessments of competence.

Alternatively, the resident can be put on administrative leave of absence (LOA) until the remediation period begins. As this is a program-initiated leave, this is a paid leave only to give enough time to commence remediation.

During this time, it is advised the resident take initiative to start some remedial activities, if possible, such as studying, doing online course work, attending coaching sessions, etc. This is not considered a vacation period. If the resident would like to go on vacation at this time, they can do so.

Note that remediation does NOT have to align with the regular rotation schedule. A remediation period can start and end at any time. However, we recognize, due to scheduling, that it is often easier for programs to stay within regular rotation dates. We encourage an expedient start to remediation whenever possible.

How do I address performance deficiencies?

Recognizing that a learner is in need of extra support to achieve their potential is an essential role of a clinician teacher. It is in the resident’s best interest to have difficulties in any competency domain flagged early so that it can be promptly addressed through learning supports. Once you have identified difficulties, the program director will work with the PGME Office to take the next steps, on how to help the resident, and develop and implement a plan. Once difficulties have been identified, you will trigger a mechanism of support that endeavors to help the learner succeed and provides the program with guidance and additional resources to do so.

A resident must be assessed honestly, fairly, and objectively. It is important to record what you see and to be able to support comments with objective examples. It is important to provide feedback to the resident promptly. If you are uncertain how to proceed with your assessment, or if you feel the resident has displayed difficulty in accepting your feedback, contact the Program Director for guidance. Always document descriptive comments on the resident’s evaluation.

For further information around assessment, please refer to the Resident Assessment Policy.

As PD, what do I do if I hear about difficulties but there is no documentation?

It is best to try and get documentation pertaining to any conversations around struggling learners. For example, if this was an in-person conversation or a phone call, you could follow-up with an e-mail confirming the nature of the conversation. Make sure that the information is communicated to the resident as well. Always ask the evaluating faculty to document their thoughts on evaluations or ITERs and to provide the feedback to the resident.

If there is a pattern of these conversations occurring, it is advised that the Program Director have a meeting with the resident to discuss some of the concerns identified. It would also be a good idea to review the resident ITERs for any subtle hints of struggle (i.e. in the comments sections) and address these with the resident. Developing a Learning Support Plan as soon as possible would be a prudent next step.

It is advised that concerns around the resident be addressed at the next RTC meeting, to determine the next most appropriate steps.

Does Remediation extend a learner’s training?

If a learner is being considered for Remediation they should not be promoted to the next level of training unless full competency is demonstrated at the current level of training. Promoting a learner who is not ready to transition into a more senior role with more responsibilities and complexity threatens the safety of patients, and the overall success of the resident in their training.

Remediation often requires extension of training as the rotations are significantly adjusted and changed from regular rotations. The decision regarding the length of extension is made by the RTC at the end of the Remediation and is submitted to PGME with the Remediation outcome form. A waiver of training cannot be requested near the end of residency if the extension was a result of Remediation.

How does LSP, remediation, probation affect the resident?

When a resident goes on Learning Support or Remediation, this information, stays within the Program and PGME records only. A learner put on Probation will be reported to both the CPSA and AHS by the PGME Associate Dean as part of our reporting requirements.

What if there is concern around the wellness of the learner?

If there is ever any suspicion that a learner is not well, this should be directly discussed with the resident as soon as possible. Ask them directly if they are experiencing any health or wellness difficulties that could be impacting their performance and refer them to the Physician Family Support Program (PFSP), by calling 1-877-SOS-4MDS (767-4637). This is a 24/7/365 line available to both physicians and residents requiring advice. The resident is also encouraged to contact the Office of Resident Affairs and Physician Wellness.

Wellness concerns should be addressed prior to implementing Remediation or Probation. The learner may need to take a medical leave of absence (see PARA Contract for guidelines around leaves) until their issue has been addressed or stabilized before embarking on Remediation or Probation.

Who do I contact if I have any questions about a learner in difficulty?

The PGME Learner and Education Resource Specialist and Director of Learner Resources act as consultants to programs regarding any questions about their learners in difficulty. They advise on process and policy, developing Remediation contracts and Learning Support Plans, coordinating accommodations, and connecting programs to additional external resources to support their learner in need.

For any questions or concerns regarding a learner, please contact the PGME Learner and Education Resource Specialist at pdassist@ucalgary.ca.

Follow this link for a complete list of PGME contacts.

What if my learner has an identified or suspected disability?

It is expected, and is the learner’s responsibility, that disabilities and accommodation requirements are disclosed to the program in order that appropriate accommodations can be discussed and put into place. Application forms for accommodations are available on the PGME website. All applications for accommodations are reviewed by the Accommodation Assessment Committee at PGME.

Programs are required to provide the learner with appropriate reasonable accommodation that is in alignment with recommendations but does not compromise the integrity of the program or expectations of the learner. A learner must still be capable of meeting all objectives of training given reasonable accommodations. Deciding upon and implementing appropriate accommodations is a collaborative effort between the program, the PGME Office, and the AHS Medical Education Office.

It is possible that a learner enters residency with an undiagnosed disability that emerges during their residency training. If there is a suspicion of a learning disability, a psycho-educational assessment can be coordinated with the PGME Office, through PFSP. A formal request needs to be submitted to the PGME Office for consideration.

What if my learner in difficulty wants to transfer programs?

A learner in difficulty who is not currently on Probation is allowed to participate in the formalized transfer process. If a learner is in the process of Probation, then the learner is not eligible to participate in the transfer process until they have successfully completed Probation. It is important to address the idea of transfer EARLY to avoid difficulties transferring at a later stage.

For additional information on the transfer process, please review the Resident Transfer Policy on the PGME Policies webpage.