Many of us view the goal of the ACGME's outcomes project as producing competent residents. But the emphasis on competency extends to us, in our own continuing professional development, as well as our programs. Perhaps of greatest importance, is the implicit emphasis on creating competent programs and institutions in which our trainees train. Generally our best learning opportunity is not the self-motivated, self-actualized, "model resident". Rather, we usually stretch the most by encountering resident situations that are in some way "challenging". For an individual program director, these opportunities are usually relatively rare. But there is the inevitable "first time", when you encounter one or more of the tough issues: substance abuse, depression, and burnout among others. Fortunately, these are almost never encountered on the same day. This project was conceived as a tool to give program directors, faculty, and residents the opportunity to think through many of these situations prospectively. In the safety of a learning setting, "12 vignettes" such as the ones presented in this program, can be reflected on without the usual complicating factors such as dealing with particular personalities, or the frenzy of immediate decision-making. Each of these vignettes is discussed by one or more content experts. I hope these curricula can serve as a tool for implementing effective strategies to address fatigue and impairment. Ideally, we hope to prevent certain situations, and when not prevented, to identify early, and manage respectfully and responsibly. As we do so, we demonstrate practice-based learning and improvement, as well as professionalism, systems-based practice, and interpersonal, and communication. The vignette on "Legal Issues in GME" may help inform an institution's view of remediation policies in GME.
KeywordsGME, Graduate Medical Education, Policy, Legal, Remediation Challenging, Policies
Kathryn M. Andolsek, MD, MPH, Duke University School of Medicine
R.B. Friedlander, JD
Victoria Green, MD, JD, MBA, MHSA
Jamie S. Padmore, JD
Kerry M. Richard, JD
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