Policy on Selection, Evaluation, Promotion, and Dismissal of Residents for the ACGME Accredited Program in Otolaryngology-Head and Neck Surgery at the University of Washington.

I. Selection

The residency selection process attracts a large number and wide range of highly competitive applicants. The applicants utilize ERAS for Otolaryngology to submit an application to our program. Medical students are selected only through the NRMP ERAS matching program. The following items are required: CAS Common Application Form, personal statement, medical school transcript, Dean’s letter, USMLE scores, and 3 letters of recommendation.

A screening committee consisting of 4 faculty members initially reviews the applications. The committee forwards recommendations to the Chair who selects a subset of appropriate applicants for personal interviews. A group of 8 faculty members including clinicians and basic science researchers are involved in the personal interviews. Three separate interview dates are offered in December and January. Applicants can expect to receive a general overview of the program, and to have interviews with 8 members of the faculty. All interviewers will have access to the application materials. Interviewers will rate applicants on a variety of criteria, including medical school performance, personal attributes, exposure to the field, and goals, including research and clinical interests. Interviewers will use both the application materials and their interactions with the applicants to assign the ratings or make summary comments. Applicants will also have access to residents on the day of interview. At the time of interview, applicants will be provided with additional written information about the program that may include descriptions of the clinical rotations, the didactic program, the residency position appointment agreement, and the “Essential Abilities” requirements. Applicants will be requested to review the “Essential Abilities” document, and to notify the program director of requested accommodations, if applicable.

Development of the rank list for the match involves all members of the residency selection committee. Each member will develop his or her own rank list. Criteria that may be considered include medical school performance, letters of recommendation, interview performance, research interest, career goals, and input from residents or other members of the staff who met the applicants (not solicited, but accepted). A meeting of the residency selection committee will be held in February to develop a consensus of rank order and which candidates will not be ranked. The program director and Chair may review and revise the final list if needed. The final ranking list is submitted to the NRMP. The Director of the Office of Graduate Medical Education Program Assessment and Development and the institution’s Graduate Medical Education Committee review the results of the match each year.

In the case of vacancies following the match, applicants may be interviewed at any time. Up to 3 faculty will be involved in the interview process. The residency training director will decide whether to offer a position, or whether further review by the whole residency selection committee is indicated after the interview. A letter offering the position and specifying the post-graduate year of the initial appointment and salary level will be provided to the selected applicant, who will sign and return an agreement to the appointment. The appointment will be contingent upon receipt of a satisfactory “Evaluation Record for a Transferring Resident or Fellow” from the previous program director.

^ Top

II. Evaluation

The faculty is responsible for ensuring that residents proceed through their educational/training program in a satisfactory manner. Clinical skills and competence should reflect a gradual and steady maturation with each rotation and new level of training. Academic requirements should be completed in a timely fashion, consistent with the department’s standards. The resident evaluation is based on cognitive, technical and interpersonal skills. Residents, who, for whatever reason, are not making satisfactory progress, will be promptly informed of this. Similarly, residents who demonstrate exceptional ability in clinical skills, teaching and research should receive appropriate and timely praise. Residents must meet the requirements outlined in the “Essential Abilities” policy to enter and continue in residency training.

Mechanisms for Evaluation

A. Clinical Rotations

Faculty should provide formative comments to the residents on a daily basis throughout the clinical rotations. At the conclusion of each rotation, 3 times yearly, all attending faculty will complete a summative written evaluation. The division chief for that rotation will discuss progress with the resident. The program director will determine if the evaluation represents satisfactory performance. If not, the performance will be discussed at a staff or residency training committee meeting. If the performance of a resident is unsatisfactory, he/she will be placed on probation and may not receive credit for the rotation. The final evaluation form will be retained in the resident’s permanent file. The resident and faculty may review the file at any time during usual working hours. A copy of our evaluation is included with this packet. The evaluation process is web-based and allows residents to see their evaluations from each site once they are completed. The evaluation form is based on the ACGME competencies of: patient care, medical knowledge, practice-based learning, systems based practice, interpersonal skills, and professionalism.

B. Coursework

UW policies and those outlined in the residency “Academic Guidelines” regarding classwork performance and scholarly activities will be followed. Participation in the departmental conference schedule is also expected. A yearly inservice examination is required for formal testing of cognitive skills. The Chairman and program director review the results.

C. Departmental Review

Review of resident performance occurs on a semi-annual basis. A mid-year evaluation occurs with the program director during a one-on-one meeting with full written evaluation placed in the residents file. Once a year, resident performance is reviewed by the full clinical and research faculty at the annual faculty retreat. This review and all previous yearly rotational reviews will then be discussed in a meeting between the Chair and each resident. This formal meeting each summer allows discussion of areas of progress and excellence as well as frank discussion of deficiencies. Written documentation of the review will be maintained in the resident file. Resident evaluations are used to determine appointment renewal status, board eligibility, and to summarize the resident’s performance each year to the American Board Otolaryngology-Head and Neck Surgery.

^ Top

III. Promotion and Reappointment

Reappointment and promotion is contingent upon adequate clinical performance and non-cognitive performance in the present year, and upon the expectations for performance at the next level of training. (Examples of non-cognitive performance include attitudes and humanistic qualities, including personal hygiene, timeliness and ability to accept constructive criticism.) Satisfactory completion of all rotations in all areas of the evaluation process and ACGME categories is required. A promotion is based on satisfactory completion of the outlined curriculum, mastery of the clinical materials and technical skills appropriate for the resident/fellow level. Residents will be expected to be in agreement with their ability to perform the technical and cognitive skills required as outlined in the “Essential Abilities” document, and to notify the program director of requested accommodations, if applicable. See attached “Essential Abilities”.

Residents will be notified of advancement or non-reappointment by January 15 each year as per the institutional policy. Decisions to not offer reappointment are uncommon and usually follow written notification of inadequacies and opportunity to improve with the assistance and guidance of the department. Careful deliberation by the faculty and Program Chair will precede any decisions to not reappoint a resident. Non-reappointments are handled in accordance with the policies outlined in the residency position appointment agreement.

Management of Problems

Evaluation of resident performance includes patient care, medical knowledge, practice based learning, systems based practice, interpersonal skills and professionalism. Each of these areas requires continuous improvement, commitment, and self-monitoring. Notable incidents of concern or praise should be channeled to the program director and integrated into a composite assessment. Concerns may be transmitted to the program director by written evaluation, letters, phone conversation, or email. When the concern is not expressed in writing, the program director will make notes of the conversation.

When problems arise, the program director will assess the quality of performance over time, the presence of temporary life crises, the educational responsiveness of the resident, and the impact of the resident on the program. The program director may notify or request assistance for remediation from the faculty advisor, department chairperson, residency education committee and/or entire faculty. Upon notification of a problem in cognitive or interpersonal performance, the program director will make an initial decision as to classification of a problem into one of three categories: minor concern, focus of concern, or academic probation. The resident will be made aware of the problem via a written statement clearly outlining the area(s) of deficiency and recommendations for improvement and be given the opportunity to respond. The program director will notify the department chair as soon as possible of either focus of concern or probation status. In questionable cases of minor concern, and for all cases of focus of concern or probation, the problem will be discussed at the senior faculty meeting. The minimum level of response to any written complaint by a patient or any risk management issue will be focus of concern status.

A. Minor Concern:

Faculty are strongly encouraged to report any concerns (verbally or in writing), however minor, to the program director so that patterns of behavior can be recognized promptly. Such concerns should be discussed with the resident. The program director will make a written notation of any verbally reported concerns and the plan of action. At the discretion of the program director, the concern may be discussed with the program chair and senior faculty.

B. Focus of Concern:

Concerns may arise over clinical performance, following department policies/procedures, academic performance (see “academic guidelines”), documentation, interpersonal skills and attitudes or other features that reflect negatively on the resident’s ability to carry out his/her duties. In making a resident a focus of concern, the department expects that the problem can be corrected immediately or in a defined period of time. The following written notice of deficiencies and corrective plan will be developed by the program director, faculty advisor and training faculty:

1. Elucidation and analysis of the problem
2. Supportive and/or corrective intervention
3. Monitoring mechanism including time until reevaluation
4. Consequences if corrective action not achieved

This focus of concern documentation will be given to the individual and will be made part of the file at the discretion of the program director. If the problem has been satisfactorily remedied at the time of re-evaluation, the focus of concern documentation may be removed from the individual's permanent file. A re-evaluation date will be established in the focus of concern documentation.

C. Probation:

Probation status may be designated due to deficits in a resident’s clinical performance, academic performance (see “academic guidelines”), failure to achieve focus of concern resolution, or a second incident during or following previous focus of concern status. In placing a resident on probation, the following written notice of deficiencies and corrective plan will be developed by the program director, faculty advisor, and training faculty:

1. Elucidation and analysis of the problem
2. Supportive and/or corrective intervention
3. Monitoring mechanism including time until reevaluation
4. Consequences if corrective action not achieved

This documentation will become a part of the resident’s permanent file and may be disclosed to other agencies or persons when the physician seeks hospital privileges or licensure. Reevaluation to remove probation status will occur at senior faculty meetings. Failure to achieve corrective action may result in extension of probation, non-renewal of appointment, or dismissal.

^ Top

IV. Dismissal

Residents may be dismissed from the program for failure to meet program standards. Due process guidelines for termination for cause will be followed as outlined in the policies in the residency position appointment agreement. The basis for termination will be the evaluation of the professional performance and non-fulfillment of the conditions of appointment both to the training program and to the clinical sites to which the resident/fellow is assigned. Prior to termination the resident will have a detailed meeting with the Program Chair and Program Director to discuss the specific deficiencies. The resident/fellow appointment may be terminated with 30 days written notice for cause by the Dean of the School of Medicine by action on, or acquiescence to, the recommendation of the Department Chair. These policies are standard for all accredited programs sponsored by the University of Washington School of Medicine.

^ Top