PDF(Pubmed)
Abstract：
BACKGROUND: In the Netherlands, 2 to 10% of the residents terminate training prematurely. Infrequently, termination of training is by dismissal. Incidentally, residents may disagree, dispute and challenge these decisions from the programme directors. Resident dismissal is always a difficult decision, most commonly made after, repeated assessments, and triangulation of the resulting assessment data and one or more remediation attempts. Nevertheless, the underlying reasons for dismissal and the policies for remediation and dismissal may differ between training programmes. Such differences may however impact the chance of remediation success, the chance of dismissal and subsequent residents\' appeals.
METHODS: We included a total of 70 residents from two groups (community-based and hospital-based specialties) during 10 years of appeals. Subsequently, we compared these groups on factors potentially associated with the outcome of the conciliation board decision regarding the residents\' dismissal. We focused herein on remediation strategies applied, and reasons reported to dismiss residents.
RESULTS: In both groups, the most alleged reason to dismiss residents was lack of trainability, > 97%. This was related to deficiencies in professionalism in community-based practice and medical expertise in hospital-based specialties respectively. A reason less frequently mentioned was endangerment of patient care, < 26%. However, none of these residents accused of endangerment, actually jeopardized the patients\' health, probably due to the vigilance of their supervisors. Remediation strategies varied between the two groups, whereas hospital-based specialties preferred formal remediation plans in contrast to community-based practice. A multitude of remediation strategies per competency (medical expertise, professionalism, communication, management) were applied and described in these law cases.
CONCLUSIONS: Residents\' appeals in community-based practice were significantly less likely to succeed compared to hospital-based specialties. Hypothesised explanatory factors underlying these differences include community-based practices\' more prominent attention to the longitudinal assessment of professionalism, the presence of regular quarterly progress meetings, precise documentation of deficiencies, and discretion over the timing of dismissal in contrast to dismissal in the hospital-based specialties which is only formally possible during scheduled formal summative assessment meetings.
METHODS: We included a total of 70 residents from two groups (community-based and hospital-based specialties) during 10 years of appeals. Subsequently, we compared these groups on factors potentially associated with the outcome of the conciliation board decision regarding the residents\' dismissal. We focused herein on remediation strategies applied, and reasons reported to dismiss residents.
RESULTS: In both groups, the most alleged reason to dismiss residents was lack of trainability, > 97%. This was related to deficiencies in professionalism in community-based practice and medical expertise in hospital-based specialties respectively. A reason less frequently mentioned was endangerment of patient care, < 26%. However, none of these residents accused of endangerment, actually jeopardized the patients\' health, probably due to the vigilance of their supervisors. Remediation strategies varied between the two groups, whereas hospital-based specialties preferred formal remediation plans in contrast to community-based practice. A multitude of remediation strategies per competency (medical expertise, professionalism, communication, management) were applied and described in these law cases.
CONCLUSIONS: Residents\' appeals in community-based practice were significantly less likely to succeed compared to hospital-based specialties. Hypothesised explanatory factors underlying these differences include community-based practices\' more prominent attention to the longitudinal assessment of professionalism, the presence of regular quarterly progress meetings, precise documentation of deficiencies, and discretion over the timing of dismissal in contrast to dismissal in the hospital-based specialties which is only formally possible during scheduled formal summative assessment meetings.
摘要：
背景：在荷兰，2～10%的住院医师过早终止培训。很少,终止培训是由解雇。顺便说一句,居民可能不同意，对计划主任的这些决定提出异议和质疑。解雇居民总是一个艰难的决定，最常见的是之后，反复评估,以及所得评估数据的三角测量和一个或多个补救尝试。然而，培训计划之间解雇的根本原因以及补救和解雇政策可能有所不同。然而，这种差异可能会影响补救成功的机会，解雇和随后的居民上诉的机会。
方法：在10年的上诉中，我们共纳入了来自两组（社区和医院专科）的70名居民。随后，我们就可能与调解委员会关于居民解雇的决定结果相关的因素对这些群体进行了比较。我们在此专注于应用的补救策略，以及报告解雇居民的原因。
结果：在两组中，最据称解雇居民的原因是缺乏培训能力，>97%。这分别与社区实践中的专业素养和医院专业中的医学专业素养不足有关。一个不太常见的原因是危及患者护理，<26%。然而,这些居民都没有被指控危害他人，实际上危害了病人的健康,可能是由于他们主管的警惕。两组的补救策略各不相同，与以社区为基础的实践相比，以医院为基础的专业更喜欢正式的补救计划。每个能力都有多种补救策略(医学专业知识，敬业精神,通信,管理)在这些法律案件中被应用和描述。
结论：与以医院为基础的专业相比，以社区为基础的实践中居民的上诉成功的可能性要小得多。这些差异背后的假设的解释因素包括基于社区的实践，更突出地关注专业的纵向评估，定期举行季度进度会议，对缺陷的精确记录，与解雇医院专科的时间相反，解雇时间的自由裁量权只有在预定的正式总结性评估会议期间才能正式进行。
方法：在10年的上诉中，我们共纳入了来自两组（社区和医院专科）的70名居民。随后，我们就可能与调解委员会关于居民解雇的决定结果相关的因素对这些群体进行了比较。我们在此专注于应用的补救策略，以及报告解雇居民的原因。
结果：在两组中，最据称解雇居民的原因是缺乏培训能力，>97%。这分别与社区实践中的专业素养和医院专业中的医学专业素养不足有关。一个不太常见的原因是危及患者护理，<26%。然而,这些居民都没有被指控危害他人，实际上危害了病人的健康,可能是由于他们主管的警惕。两组的补救策略各不相同，与以社区为基础的实践相比，以医院为基础的专业更喜欢正式的补救计划。每个能力都有多种补救策略(医学专业知识，敬业精神,通信,管理)在这些法律案件中被应用和描述。
结论：与以医院为基础的专业相比，以社区为基础的实践中居民的上诉成功的可能性要小得多。这些差异背后的假设的解释因素包括基于社区的实践，更突出地关注专业的纵向评估，定期举行季度进度会议，对缺陷的精确记录，与解雇医院专科的时间相反，解雇时间的自由裁量权只有在预定的正式总结性评估会议期间才能正式进行。
