Vanderbilt Resident Evaluation,
Promotion and Disciplinary Policy


The following evaluation and disciplinary guidelines apply to house staff (residents and clinical fellows) as part of their Vanderbilt University Medical Center training programs. The purpose of these guidelines is to provide a system for evaluation of the performance of house staff and procedures to deal with unsatisfactory academic performance and/or other conduct. 

Length of Appointment:  Appointments are made for a one-year term, with renewal of the appointment based on satisfactory performance by the house officer and the availability of a position. Terms and conditions of the appointment are specified in the yearly contracts and are further described in the Vanderbilt House Staff Manual.       

             
A. Resident Evaluation

The Vanderbilt Internal Medicine program evaluations shall use criteria and procedures appropriate to the Internal Medicine Program and shall include, but are not limited to the core competencies (Patient Care, Medical Knowledge, Communication and Interpersonal Skills, Problem-Based Learning and Improvement, Professionalism, and Systems-Based Practice) as defined by ACGME. 

The following items are taken directly from the Vanderbilt Housestaff Manual. The following policies apply to internal medicine residents, as they apply to all housestaff who are training at Vanderbilt.

1. A written evaluation of a house officer addressing medical knowledge, competence in patient care, professionalism, system-based practice, interpersonal and communication skills, and practice-based learning and improvement will be completed at the end of each rotation or assignment. The program director or faculty designee will share the evaluation(s) with the house officer and provide feedback. These evaluations will occur at least semi-annually, will include a written review of performance, and should also include a discussion of areas of deficiency and plans for improvement.

2. The written evaluation and any documentation regarding the meeting should be permanently maintained in the departmental file.

3. Any information, materials, incident or other reports, statements, memoranda, or other data which are subject to the Tennessee Medical Peer Review statute (T.C.A. §63-6-219) are privileged and are not to be copied or released without the prior authorization of the Associate Dean for Graduate Medical Education or his/her designee.

4. The evaluations, evaluation summaries and/or other non-privileged documents provided by the GME Office and/or department to the Review Committee, as determined by each program, may be reviewed by the house officer with the Program Director, the Associate Dean for Graduate Medical Education, or an individual designated by the Associate Dean for Graduate Medical Education upon request.

5. Copies of correspondence between the house officer and the Program Director, or any other correspondence directed to or on which the house officer was copied, will be provided to the house officer upon request to the Program Director. This provision lonely applies to correspondence maintained in program, departmental, or GME files.


B. Informal Counseling

In addition to evaluations, Program Directors and attending or supervising physicians provide and document timely feedback on an ongoing basis, which includes positive feedback as well as minor performance or conduct concerns as they occur and are documented as such. 


C. Corrective Action

1. Corrective Action is taken to address any concern about the house officer's performance or conduct which is too serious to be resolved by Informal Counseling or was not corrected by Informal Counseling. Performance or conduct issues subject to corrective action include, but are not limited to, the following examples:

---Insufficient medical knowledge.
---Inability to apply medical knowledge effectively, whether in patient care, research, or performance technical skills.
---Any deficiency or conduct which adversely bears on the individual's performance, such as attitude, conduct, interpersonal or communication skills, or other misconduct.
---Failure to progress or perform at the expected level of training.
---Violations of professional responsibility, University or Medical Center by-laws, policies and procedures, state or federal law or any other applicable rules and regulations.

2. Initiation of Corrective Action

There may be concerns regarding the performance or conduct of a house officer which have not been remedied or should not be addressed with feedback or Informal Counseling. In those situations, one of the actions listed below (Warning(s), Probation, Summary Suspension, Dismissal or Non-renewal) is taken, depending on the nature and/or severity of the deficiency, actions, or conduct. In determining which level of intervention is appropriate, the Program Director should take into account the house officer's overall performance, including previous evaluations, Informal Counseling, Warnings, and Probationary Periods. 

a. Warning

A Warning is appropriate if concerns arise or continue regarding the performance or conduct of a house officer which are too serious to be dealt with by Informal Counseling but which do not impact the health or safety of patients or others. (Actions that may adversely impact on health or safety of patients or others are addressed by Probation, Summary Suspension and/or Immediate Dismissal.) A Warning will be given to the house officer explaining why the conduct or performance is unacceptable. Examples of such unacceptable conduct/performance include, but are not limited to, failure to respond to Informal Counseling, unprofessional conduct, and poor in-service scores. A Warning may be given verbally or in writing, but will be documented in the house officer's departmental file, with a copy to the Associate Dean for Graduate Medical Education. The house officer will be advised by the Program Director or designee about expectations for improvement of the deficiency or conduct and be given a time frame in which to meet these expectations.  During or at the end of the Warning Period the house officer will meet with the Program Director or designee to advise the house officer whether the deficiency or conduct has been corrected or whether further corrective action will be taken. If the house officer does not correct or improve the conduct or deficiency within the Warning Period, or if the same or additional conduct or deficiency occurs within that period, then the Program Director may immediately place the house officer on Probation, recommend non-renewal, or recommend immediate dismissal. At any time, whether before or after the Warning Period has passed, the Program Director may recommend further action. 

b. Probation

If a house officer's academic performance, performance of duties, attitude, deportment, or interpersonal or communication skills falls below acceptable standards or other deficiencies exist which are not corrected by Informal Counseling or a Warning, or are of a serious nature such that Informal Counseling or a Warning are not appropriate, the house officer is placed on Probation by the Departmental Chairman, Program Director, or Associate Dean of GME. The house officer will be informed in writing by the Departmental Chairman, Program Director, or Associate Dean for Graduate Medical Education (GME) that he/she is being placed on Probation. The notification should include an explanation of the deficiencies, performance or conduct giving rise to Probation, and the time period of the Probation. The length and conditions of the Probationary Period are determined by the Departmental Chair and/or Program Director, after consultation with the Associate Dean for GME. A copy of the written notification of Probation shall be sent to the Associate Dean for GME and the house officer. The effective date of the Probationary Period will be the date of the written notification.

Expectations for improvement of the house officer's performance, deficiency or conduct are conveyed to the house officer by the Departmental Chair and/or Program Director, together with a copy of these guidelines. During the Probationary Period, efforts are made to advise and assist the house officer to address the performance issues and/or correct deficiencies or conduct with the goal of the house officer successfully completing the program.  If at any time during the Probationary Period additional performance or conduct issues arise, or if the issues which resulted in the Probation continue, the Program Director may extend the Probation, recommend Nonrenewal, or move to Summary Suspension or Immediate Dismissal.  At the end of the Probationary Period, the Departmental Chair or Program Director determines which of the following actions will be taken and notifies the house officer: 
 
1. Remove the house officer from probationary status.
2. Extend the probationary period.
3. Notify the house officer of non-renewal of his/her appointment.
4. Notify the house officer of his/her immediate dismissal. 

The Associate Dean of GME is notified of the actions in 1 through 4 above. 

c. Summary Suspension

If at any time a house officer's conduct requires that immediate action be taken to protect the health or safety of patients or others, or to reduce the substantial likelihood of immediate injury or damage to the health or safety of patients or other persons, any member of the Medical Staff, the Hospital Administrator on Call, or the Associate Dean for GME shall have the authority to summarily suspend the house officer.

If a house officer exhibits performance or conduct that is too serious to warrant a Warning or Probation, the house officer may also be summarily suspended by the Department Chair, Program Director, or Associate Dean for GME.

The Summary Suspension will be reported immediately in writing to the Associate Dean for GME and the resident's Program Director and Chair, with a copy to the house officer. The house officer will remain in paid status while on Summary Suspension.

The Associate Dean for GME, after review of the circumstances giving rise to the Summary Suspension and after consultation with the Chairman and Program Director, determines a course of action which includes one or more of the following:

1. Lifting, modifying or extending the Summary Suspension;
2. Probation;
3. Notification of Non-renewal of contract;
4. Immediate Dismissal.

The resident is notified in writing, with copies to the resident's Program Director and Chair, of the action taken, and that he/she may not be present in the clinical areas or otherwise participate in on-campus GME activities unless specifically instructed. In the event of Summary Suspension or Immediate Dismissal, if the resident wishes a review, he/she should notify the Associate Dean for GME in writing (C/O GME Office during the business hours 8 a.m. - 4:30 p.m.) within 5 business days of the time written notification of the action was provided to the resident or sent to the resident's home address. 

d. Dismissal

Performance issues or conduct not resolved by a Warning or Probation, or other serious actions or behavior may result in Immediate Dismissal. If at any time, including during or at the end of a probationary period, the Department Chair or Program Director determines that Immediate Dismissal is warranted, he/she, notifies both the house officer and the Associate Dean for GME. The house officer is relieved of all clinical duties upon notification that the dismissal is warranted. The Department Chair or Program Director will consult with the Associate Dean for GME to determine the effective date of termination.

The resident will be notified in writing of the action taken, and that he/she may not be present in the clinical areas or otherwise participate in on-campus Graduate Medical Education. Any medical center equipment including, but not limited to, pagers, ID badges, keys, PDAs, parking cards, laptops, email privileges, is revoked upon dismissal. In addition, all access to VU computers is terminated. 

e. Response of House Officer
The house officer has 5 business days from the time written notification of the dismissal recommendation is provided to the house officer or sent to the house officer's home address to choose one of two alternatives: 

1. Accept the Dismissal without requesting a review.
2. Request a review of the Dismissal. 

The response of the house officer must be submitted in writing to the Associate Dean for GME and received in the GME Office by 4:30 p.m. on the fifth business day after notification of dismissal. Failure to notify the Associate Dean's office within this time frame is considered acceptance of the Dismissal. 

f. Review Procedure for Summary Suspension or Dismissal

Residents can request a review of a Summary Suspension or Dismissal.

In the event that the house officer submits a written request for review after Summary Suspension or Dismissal, the Associate Dean/Director of GME or his/her designee asks the Chair of the Graduate Medical Education Committee (GMEC) to convene the Review Committee of the GMEC ("Review Committee") 14 calendar days from the date of the house officer's request for review, unless the Chair of the GMEC determines there are valid reasons to extend this time frame. The review should be completed within 30 calendar days of the request for review. The Review Committee will review the circumstances leading to this action.  The Review Committee consists of no fewer than six members of the current GMEC, except for the following: the Dean of the Medical School, the Associate Dean for Graduate Medical Education, and the Dean's Chief of Staff. The Review Committee must contain at least three house staff and three faculty members none of which may be from the appealing resident's department. The Review Committee may review this request only when a quorum of the Review Committee is present. A quorum shall consist of at least two of the house staff members and at least two of the faculty members of the Review Committee. 

Any member of the Review Committee (faculty or house staff) who has a conflict or potential conflict of interest involving the appealing house officer should recuse himself or herself from the committee and a new member of the Review Committee will be appointed by the Chair of the GMEC. However, to the extent the recused member has knowledge of or was involved in the events leading up to the corrective action, he or she may still be a witness. Likewise, if there is a conflict or potential conflict of interest between the chair of the GMEC and the appealing house officer, the Review Committee will elect an alternate chair for the purposes of the review. Otherwise, the Chair of the GMEC will chair the Review Committee.


If there is failure to reach a quorum, due to multiple recusals or other reasons, the Associate Dean for Graduate Medical Education, or Chair of the Review Committee of the GMEC, shall appoint (a) new member(s) to the Review Committee. All relevant academic records and other documentation, as well as names of potential witnesses will be provided to the Review Committee as a part of the review process. The house officer will be given access to records as defined in Sections IV.A.4 and IV.A.5, and to other non-privileged documents provided to the Review Committee.  The house officer may, if he/she so desires, appear before the Review Committee and be given an opportunity to make a statement.  The house officer may also identify witnesses to be called or documents to be considered by the review committee and is responsible for providing such witnesses and documents. Witnesses are limited to those who were directly involved with the circumstances giving rise to the action or who are knowledgeable of the circumstances. Retaliation against witnesses who participate in this process in good faith is not tolerated.

The GMEC can request additional witnesses or documents. Witnesses are limited to those who were directly involved with the circumstances giving rise to the action or who are knowledgeable of the circumstances.
The review is conducted without the presence of attorneys for either party. However, either party may consult with its own counsel prior to such review or during a break in the proceedings.
The Chair of the Review Committee appoints a recording secretary to be present during the review.

After completion of the review, the Review Committee submits a written summary of the proceedings and recommendations to the Dean, who makes the final decision. A copy of the summary is maintained in the GME Office and by the Chair of the Review Committee. The Dean notifies in writing the house officer, the Program Director, the Departmental Chair/Clinical Service Chief, the Associate Dean for GME, and other appropriate persons for whom notification of the Review Committee's actions is deemed necessary.

Retaliation against a resident for requesting a review of the dismissal is not tolerated and will result in appropriate disciplinary action. 

g. Non-renewal

Non-renewal of a house officer's contract may be appropriate for a number of reasons, including but not limited to, insufficient medical knowledge, incompetence in patient care, lack of professionalism, inability to effectively use resources, poor interpersonal and communication skills, and inability to participate in practice-based learning. Ordinarily, written notice of Non-renewal of a house officer's contract shall be given no later than four months prior to the end of the house officer's current contract. In the event that notice cannot be given within four months, it shall be given as soon as possible.

If a house officer receives notice of Non-renewal and chooses to initiate a review, he/she must notify the Associate Dean of Graduate Medical Education within fourteen days and request the initiation of the House Staff Complaint/Grievance Procedure in the House Staff Manual. If, in the event that within the fourteen day period, the Departmental Chairman/Clinical Service Chief and the house officer have resolved the matter to their mutual satisfaction (and the Departmental Chairman/Clinical Service Chief notifies the Dean in writing), a Review Committee of the GMEC need not be convened and the request for review will be considered withdrawn. In either case, the Program Director and the Associate Dean for GME are advised of the outcome.