Step #5: Implementation

Remediation is a challenging time. Support is required for both the program and the resident. The following table outlines the roles and responsibilities with respect to the identification of the learner, plan development, and approval process of the learning plan ready for implementation:

Associate Dean PGME	Approves extension requests Signs remediation & probation documentation
PGME Office Director, Learner Resources	Advises programs, Program Directors, RTC on policy and process Collaborates with Program Director or Delegate in developing remediation/probation contract Supports Program Directors through remediation, probation, dismissal and appeals
PGME Office Education and Learning Resource Specialist	Advises residents and programs on policy and process Provides learning support resources when developing learning plans, remediation, and probation Meets with and provides learning support for residents with learning difficulty
PGME Office Learner Academic Support and Assessment Committee	Reviews policies and procedures around remediation and probation. Reviews remediation and probation plans Advises Programs and Program Directors in complex cases of learner difficulties
Program Director or Delegate	Contacts PGME regarding remediation and probation Collaborates with PGME Office in developing remediation/probation contracts and preparing learning plans Approves and signs remediation and probation documentation Communicates with the resident concerning progress in their training and around learning plans and advises resident around appropriate and relevant policies Meets with the resident regularly during remediation and/or probation
Residency Training Committee or Equivalent	Makes final decisions around the resident’s training progress, need for learning support, remediation, or probation plans Reviews learning, remediation, and probation plans
All Preceptors	Identify when a learner is experiencing difficulty or is performing below expected levels Notify the Program Director of specific issues Provide timely resident feedback Document all feedback
Remedial Preceptors	Provide assessment as required and outlined in the remediation/probation contract Provide resident with feedback Document all feedback provided Regularly update the Program Director of resident progress or continuing concerns throughout the remedial or probationary period
Mentor	Provides career guidance and support during residency Facilitates resident reflection on their progress Meets regularly with resident throughout remediation/probation Not involved in formally evaluating the resident during remediation/probation Does not provide legal advice
Resident	Provides input into their learning plan Signs off on remedial and probationary documentation Fully participates in required activities Responsible for disclosing any issues affecting their ability to perform in their training to the program director
Ombudsman	Confidential resource for resident to discuss all residency matters, including learning difficulties, remediation, probation, dismissal Provides impartial process-oriented advice to the learner Does not provide legal advice Facilitates resolution of conflicts or concerns raised by the resident
PGME Office Directors of Resident Support	First point of contact for complaints regarding safe learning environment including concerns regarding bullying, harassment, and/or discrimination. Sit on LASAC Committee
CanMEDS Coaches	An external resource available to residents who are on remediation and probation Provide one-on-one mentoring and tutoring in the areas of Communication, Collaboration, Professionalism, and general Academic Support Do not assess improvement in the CanMEDS roles directly (this should become evident through rotation assessments) Provide feedback on in-session engagement, professionalism, and participation of the resident
Office of Resident Affairs and Physician Wellness	Confidential services supporting resident health and well-being

A remedial program typically runs over the course of 12 weeks. The remediation plan can be designed so that it can be integrated into the resident’s regular working/rotation schedule; however, modifications to rotations may be required to address the objectives of remediation activities. The resident may continue to work in the same learning environment but with modified responsibilities, assessments, and learning activities as outline by the remedial plan.

Overall, the program is responsible for the implementation of the plan as outlined, while the PGME Office offers program support during implementation with respect to providing educational resources and additional funding required for some remedial activities (need to be pre-approved). Additionally, there must be room for flexibility since remedial learning plans may be fluid and may have to be modified during the remedial process should circumstances arise or new more pressing concerns emerge. Although this is not frequent, programs should be prepared for flexibility and maintain contact with the PGME Office throughout the remedial period.

Finally, Information must also be shared with supervising preceptors about identified deficiencies and done in a supportive manner to enhance implementation. Sharing of relevant information to facilitate remediation for the resident can help with assessment and directed teaching toward specific resident needs. Any explicit areas of concern such as required task supervision must be shared with the preceptors engaged in remedial supervision and all must be made aware when patient safety concerns have been identified.

Step #5: Implementation

A. Identifying Sources of Support.

B. Implementation of the Remediation Plan