The Fundamentals of Resident Dismissal

Residents have the rights and responsibilities of both students and employees. Dismissal of a resident from a training program is traumatic and has lasting repercussions for the program director, the faculty, the dismissed resident, and the residency. A review of English language literature was performed using PUBMED and OVID databases, using the search terms, resident dismissal, resident termination, student dismissal, student and resident evaluation, legal aspects of education, and remediation. The references of each publication were also reviewed to identify additional appropriate citations. If the Just Cause threshold has been met, educators have the absolute discretion to evaluate academic and clinical performance. Legal opinion has stated that it is not necessary to wait until a patient is harmed to dismiss a resident. Evaluations should be standard and robust. Negative evaluations are not defamatory as the resident gave consent to be evaluated. Provided departmental and institutional polices have been followed, a resident can be dismissed without a formal hearing. Residencies are entitled to modify academic requirements and dismissal is not considered a breach of contract. Although there is anxiety regarding resident dismissal, the courts have uniformly supported faculty having this role. When indicated, failure to dismiss a resident also places the program director and the faculty at risk for educational malpractice.

[1]  E. Aagaard,et al.  Learner Deficits and Academic Outcomes of Medical Students, Residents, Fellows, and Attending Physicians Referred to a Remediation Program, 2006–2012 , 2014, Academic medicine : journal of the Association of American Medical Colleges.

[2]  S. Verma,et al.  Remediation of Residents in Difficulty: A Retrospective 10-Year Review of the Experience of a Postgraduate Board of Examiners , 2013, Academic medicine : journal of the Association of American Medical Colleges.

[3]  Joseph M. Galante,et al.  General surgery resident remediation and attrition: a multi-institutional study. , 2012, Archives of surgery.

[4]  D. Irby,et al.  Remediation of the Deficiencies of Physicians Across the Continuum From Medical School to Practice: A Thematic Review of the Literature , 2009, Academic medicine : journal of the Association of American Medical Colleges.

[5]  L. Torbeck,et al.  Remediation practices for surgery residents. , 2009, American journal of surgery.

[6]  S. Lurie,et al.  Measurement of the General Competencies of the Accreditation Council for Graduate Medical Education: A Systematic Review , 2009, Academic medicine : journal of the Association of American Medical Colleges.

[7]  A. Messner,et al.  Letters of Recommendation to an Otolaryngology/Head and Neck Surgery Residency Program: Their Function and the Role of Gender , 2008, The Laryngoscope.

[8]  G. Arnold,et al.  Performance during Internal Medicine Residency Training and Subsequent Disciplinary Action by State Licensing Boards , 2008, Annals of Internal Medicine.

[9]  A. Teherani,et al.  Disciplinary action by medical boards and prior behavior in medical school. , 2005, The New England journal of medicine.

[10]  R. Rhodes,et al.  Decisions regarding resident advancement and dismissal. , 2005, The Journal of bone and joint surgery. American volume.

[11]  A. Teherani,et al.  Domains of Unprofessional Behavior During Medical School Associated with Future Disciplinary Action by a State Medical Board , 2005, Academic medicine : journal of the Association of American Medical Colleges.

[12]  Allen Kachalia,et al.  Professional liability issues in graduate medical education. , 2004, JAMA.

[13]  Lisa D Howley,et al.  Direct Observation of Students during Clerkship Rotations: A Multiyear Descriptive Study , 2004, Academic medicine : journal of the Association of American Medical Colleges.

[14]  A. Teherani,et al.  Unprofessional Behavior in Medical School Is Associated with Subsequent Disciplinary Action by a State Medical Board , 2004, Academic medicine : journal of the Association of American Medical Colleges.

[15]  J. Richardson,et al.  Legal issues related to dismissing students for clinical deficiencies. , 2001, Nurse Educator.

[16]  E. Chasens,et al.  Legal aspects of grading and student progression. , 2000, Journal of professional nursing : official journal of the American Association of Colleges of Nursing.

[17]  P. Wickersham,et al.  Physicians disciplined by a state medical board. , 1998, JAMA.

[18]  J. M. Butters,et al.  Legal standards of conduct for students and residents: implications for health professions educators , 1996, Academic medicine : journal of the Association of American Medical Colleges.

[19]  T. E. Parrott Dismissal for Clinical Deficiencies , 1993, Nurse educator.

[20]  J. Short,et al.  The importance of strong evaluation standards and procedures in training residents , 1993, Academic medicine : journal of the Association of American Medical Colleges.

[21]  D. Irby,et al.  The legal context for evaluating and dismissing medical students and residents , 1989, Academic medicine : journal of the Association of American Medical Colleges.

[22]  G. Keyes Procedural due process in the dismissal of residents. , 1989, Journal of Dental Education.

[23]  J. Goclowski Legal implications of academic dismissal and educational malpractice for nursing faculty. , 1985, Journal of Nursing Education.

[24]  D. Nash,et al.  Academic dismissal for clinical reasons: implications of the Horowitz case. , 1981, Journal of Dental Education.

[25]  D. Nash,et al.  Academic and disciplinary dismissal in dental education: the legal basis. , 1980, Journal of Dental Education.

[26]  Powell,et al.  Board of Curators of the University of Missouri v. Horowitz , 1977 .