2014 Research Projects
Jeannette Guerrasio, MD
Associate Professor of Medicine
University of Colorado
School of Medicine, General Internal Medicine
Anschutz Medical Campus
Internal Medicine – HMG
Mail Stop F782
12401 East 17th Ave.
Aurora, Colorado, 80220
Graduate Medical Trainees Placed on Probation: Descriptive Statistics and Outcomes
Please consider my proposal for the President’s Teaching and Learning Collaborative, entitled, “Graduate Medical Trainees (GMTs) Placed on Probation: Descriptive Statistics and Outcomes.” Following the successful completion of medical school, physicians are required to complete additional graduate medical training prior to independent practice, also know as residency and fellowship. While it has been shown that medical students with professionalism lapses are more likely to be cited by their State Medical Boards when in independent practice 1, little is known about GMTs who underperform and are placed on academic probation due to either poor professional behavior and/or insufficient clinical skills 2,3.My proposal specifically asks, does being placed on probation as a GMT for poor professional behavior or insufficient clinical skills predict future negative professional outcomes such as disciplinary actions by State Medical Boards, lack of specialty board examination certification, or cessation of clinical practice?
In 2006, under the direct mentorship of Eva Aagaard, MD, I created a pioneering remediation program for internal medicine GMTs. The program provided a systematic approach for the identification of struggling learners, diagnosis of learner deficits, creation and implementation of a remediation plan tailored to the learners’ deficits and unbiased reassessment of subsequent performance. With much success, the program expanded to include medical students and most recently GMTs across all specialties. In 2011, there was a national call for an evidence-based approach to remediation. Since then, I have written a book on remediation of struggling medical learners, and a description of the methodologies used and our outcomes were accepted for publication in the journal Academic Medicine 5,6,7.
Placing underperforming learners on probation and providing remedial teaching is both costly and high-stakes for the learner and institution. Many undergraduate and graduate education programs struggle to balance their professional obligations as teachers with obligation to their professions and to the public. While our prior research has demonstrated that for every 1 hour of face to face faculty time with a struggling learner the odds of having a negative academic outcome such as delayed graduation, probation, transfers to other specialties or programs, withdrawal and dismissal decreased by 3%, having long-term outcome data will help further inform and guide educational institutions as they determine how much to invest in academic probation actions and remedial teaching.
The central research question of my proposal represents the first step in our understanding of the long-term trajectory of underperforming GMTs. This 10 year retrospective review will examine the academic files of all learners placed on probation prior to the implementation of the described remediation program. We will extract data about personal demographics, program type, year of training, learner deficit(s), whether mental health evaluation was mandated, program completion data, and prior licensing exam scores. For the same subjects, information will be collected from the Federation of State Medical Boards, including disciplinary actions by State Medical Boards, number of states granting licenses, lack of specialty board examination certification, and cessation of clinical practice. After descriptive statistics are analyzed, the outcomes data will be compared to the average data for all GMTs who remained in good academic standing throughout their graduate medical training. Logistic regression will be used to identify predictors of future negative outcomes.
This study will serve to provide comparison data for a second study, separate from this proposal that will be conducted in 5-10 years to compare the outcomes between learners placed on probation before and after the implementation of the remediation program.
In order to make my work available to others, I hope to present the data and conclusions at poster sessions locally and at one or more national medical education conferences, and to then publish the results in an academic medical journal. The data can then be subsequently published in a higher education journal comparing outcomes for underperforming GMTs with underperforming learners in other graduate and undergraduate programs, including PhD, PA, DNP, and JD programs.
I am able to and look forward to attending the required meetings as specified in sections titles, “What are the Benefits?” and “What commitments are expected of participants?” Given my long-standing and productive mentoring relationship with Eva Aagaard, MD, founder and director of the Academy of Medical Educators, she will serve in the collaboration as my coach. Her email address is firstname.lastname@example.org. For years, we have met twice monthly for my professional development, program development and research advising and will continue in this role. Eva is also available for the video conference meeting on June 27, 2013 from 9:15 to 11:00am. I also agree, if selected, to serve as a future coach in PTLC.
Thank you for considering my proposal. Several of the references from my literature search were written by me along with colleagues. Because the study of underperforming learners is such a new area of medical education research, there is much to be learned from other disciplines in higher education. I see the President’s Teaching and Learning Collaborative as a bridge between our campuses that will help provide connections for future educational research on struggling learners, how to maximize remediation efforts and how best to define successful remediation.
1 Papadakis MA. Teherani A. Banach MA. Knettler TR. Rattner SL. Stern DT. Veloski JJ. Hodgson CS. Disciplinary action by medical boards and prior behavior in medical school. NEJM. 2005;353(25):2673-2682.
2 Teherani A. Hodgson CS. Banach M, Papadakis MA. Domains of unprofessional behavior during medical school associated with future disciplinary action by a state medical board. Acad Med. 2005;80(10S):S17-S20.
3 Zbieranowski I, Takahashi SG, Verma S, Spadafora SM. Remediation of Residents in Difficulty: A retrospective 10-year review of the experience of a postgraduate board of examiners. Acad Med. 2013;88:111-116.
4 Hauer KE. Ciccone A. Henzel TR. Katsufrakis P. Miller SH. Norcross WA. Papadakis MA. Irby DM. Remediation of the deficiences of physicians across the continuum from medical school to practice: a thematic review of the literature. Acad Med. 2009;84(12):1822-32.
5 Guerrasio J. Teaching Those Who Need Us Most: Remediation of the Struggling Medical Learner. Irwin, PA: Association for Hospital Medical Education; 2013.
6 Guerrasio J. Garrity MJ. Aagaard EM. Medical students and physicians referred for remediation: Demographics and outcomes. Acad Med. Accepted. 4/2013
7 Guerrasio J. Aagaard EM. Methods and outcomes for the remediation of poor clinical reasoning. Acad Med. Pending revision.