Resident Assessment Process at Queen's University
1.0 Overview of Assessment Process
1.1 At the beginning of each rotation, or horizontal learning experience, the Rotation Supervisor(s) or delegate must ensure the resident is provided with:
- Learning objectives for the rotation
- List of duties, responsibilities, and expectations
- A description of assessment strategies
- A description of the structure of relationships within the health care team
- A description of the resident’s role in that health care team
In cases where the provision of above is done through email, a copy of the email should be included in the resident’s file.
1.2 Regular and timely feedback must occur throughout the rotation or horizontal learning experience.
1.3 Residents must be made aware of any concerns as these emerge over the course of the rotation or horizontal learning experience to provide opportunity for correction.
1.4 ITERs must be completed at regular intervals, at minimum at the end of each rotation or after 4 months/blocks of a horizontal learning experience.
1.5 Preparation of all assessment reports is the professional responsibility of the Rotation Supervisor(s) or delegate.
1.6 Documented mid-rotation assessments (ITER-mid) are strongly recommended for all residents.
1.7 An end of rotation assessment (ITER-end) must be documented and discussed with the resident. This feedback must be timely, and should normally occur within 1 month of completion of the rotation.
1.8 It is strongly recommended that residents be provided the opportunity to self-assess prior to arriving at End of Rotation Assessment meetings.
1.9 Completion of ITERs must be based on documented observations of resident performance.
1.10 Assessments of residents’ on-going progress in the program are the joint responsibility of the Program Director and the Residency Program Committee (RPC) and the assessment of residents must be a regular agenda item for RPC meetings.
2.0 Documentation of Assessments
2.1 Standardized assessment terminology must be used on all ITERs.
2.2 Completion of the narrative section of ITERs is strongly recommended.
2.3 Completion of the narrative section of ITERs is mandatory in cases when global performance ratings of “Does not meet expectations” are awarded.
2.4 ITERs must include the signature of the resident and the Rotation Supervisor. The resident's signature indicates only that the resident has read the report.
2.5 The resident may append a note indicating that he/she disagrees with the assessment documented in an ITER.
2.6 If the ITER is not signed, an explanatory note must be appended.
2.7 The resident shares responsibility with the Program Director for ensuring that ITERs are completed in a timely fashion, that he/she has received feedback and has signed the ITER.
2.8 Copies of ITERs and FITERs are retained in a database managed by the Postgraduate Medical Education office.
3.1 ITER forms are confidential documents. Access is normally restricted to the Program Director or delegate, the RPC, the Associate Dean, PGME or delegate, and the resident him/herself.
3.2 ITER forms are for purposes of progress and promotion, except in the case of university appeals, Royal College or CFPC proceedings or appeals, CPSO proceedings, or required pursuant to legal process.
4.0 Sharing of Performance Data
4.1 Assessment information can be shared to meet the educational needs of residents.
5.0 Rating Scales on In-Training Evaluation Reports
Two areas on In-Training Evaluation Reports (ITERs) require the use of rating scales when recording resident performance. The first lists educational objectives for the specific rotation and the second provides space to document the global performance assessment.
5.1 End of Rotation ITER (ITER-end)
Resident training programs may adopt either a 2 or 4-point rating scales for educational objectives in the body of In-Training Evaluation Reports (ITER-end):
2 POINT RATING SCALE (ITER-END)
4 POINT RATING SCALE (ITER-END)
Does not meet Expectations
Inconsistently meets Expectations
Does not meet Expectations
Where “Inconsistently meets Expectations” is used to describe: A resident’s pattern of performance that is irregular over the course of an entire rotation (e.g., meets expectation on some occasions and not at others). A normal pattern of performance would see this irregularity diminish overtime. However, should this inconsistent pattern persist throughout the duration of a rotation with no evidence of improvement that resident’s performance would be described as “Inconsistently meets Expectations”.
5.2 Global Performance Ratings
The following 2-point rating scale must be used for global performance ratings on all End of Rotation In-Training Evaluation Reports (ITER-end):
END OF ROTATION EVALUATION (ITER-END)
Does not meet Expectations
5.3 Mid-Rotation ITER Rating Scales (ITER-MID)
The following 2-point rating scale must be used for educational objectives (body of ITER-mid) and Global Performance ratings in Mid-Rotation ITERs:
2 POINT RATING SCALE (ITER-MID)
Progressing as expected
6.0 Annual Promotion Process
6.1 The Program Director or delegate must conduct an annual progress review with each resident.
6.2 The Program Director or delegate and resident should review all relevant assessment data (e.g., ITERs, OSCE results, multisource feedback, etc) and discuss patterns of strengths and weaknesses that emerge and strategies for improvement. Career counseling may also be discussed.
6.3 Resident progress is reported to RPC.
6.4 The RPC must review the files of all residents whose performance is not meeting expectations and forward a request to the Associate Dean, PGME to convene the Education Advisory Board to review these files.
6.5 Promotion of a resident to the next academic level occurs when:
6.5.1 All rotation periods during the academic year have been completed with ITER global performance ratings of “Meets Expectations”.
6.5.2 Additional criteria for promotion as stipulated by individual programs have been met including, but not limited to:
126.96.36.199a Documentation of passing the MCCQE – Part II for promotion to PGY4 level (applicable to incoming residents as of 2013).
188.8.131.52b Documentation of passing the MCCQE – Part II for promotion to PGY5 level for medical subspecialty residents matching to our programs at the PGY4 level (applicable to incoming residents as of 2013).
184.108.40.206 Documentation of passing the SFE for surgical residents requiring the SFE for certification as a criterion for promotion to PGY4 level (applicable to incoming residents as of 2013).
6.6 Under extenuating circumstances the Program Director and RPC have the discretion to waive criteria for promotion.
6.7 The decision to recommend promotion of residents to the Associate Dean, PGME will be made by the Program Director or delegate and the RPC.
7.0 Satisfactory Assessment
7.1 A satisfactory assessment is defined as any ITER having a global performance rating of “Meets Expectations”.
8.0 Incomplete Rotations
8.1 In order to meet pedagogical requirements, a resident should not miss more than 1/4 of a rotation or horizontal learning experience due to illness, leave, holidays etc.
8.2 A rotation or horizontal learning experience that includes less than 3/4 of the expected time commitment may be considered incomplete.
8.3 An incomplete rotation or horizontal learning experience should be completed, the duration of which is determined by the nature of the experience and the need for continuity of the clinical experience.
8.4 For any clinical rotation or horizontal learning experience, the Program Director or delegate in consultation with the Rotation Supervisor will determine whether or not the duration of a resident’s learning experience was sufficient to support meaningful assessment.
9.0 Unsatisfactory Assessment
9.1 An unsatisfactory assessment is defined as an ITER having a global performance rating of “Does not meet expectations”.
9.2 When a resident receives an unsatisfactory assessment the Program Director will report the occurrence to the RPC and advise the Associate Dean, PGME.
9.3 The Associate Dean, Postgraduate Medical Education will convene the Education Advisory Board (EAB) to review the file of the resident in academic difficulty and the draft remediation plan.
9.4 An unsatisfactory assessment will result in (a) a repeat of the rotation or (b) completion of a period of remediation (see item 10.0 below), or (c) may result in a probationary period (see 11.0 below).
9.5 In exceptional circumstances, the EAB may recommend that none of the options listed in item 9.4 apply.
10.1 Remediation is designed to assist the resident in addressing identified weaknesses and correcting his/her deficiencies.
10.2 A remediation plan must address all of the following elements (see Schedule A for Remediation Template):
- Identified areas of weakness requiring remediation and assessment strategies that will be used to document performance.
- The location and duration of the remediation period.
- Expected outcomes of the remediation period.
- Consequences of the successful completion or failure of the remediation period.
10.2.1 The draft remediation plan is developed by the Program Director in consultation with the RPC and reviewed with the resident.
10.2.2 The Associate Dean, PGME must be advised when there is a plan to place a resident on remediation and a copy of the draft remediation plan and complete resident file forwarded to the PGME office for review by the EAB.
10.2.3 The EAB will review the complete resident file and forward recommendations relating to (a) the process by which the need for remediation was determined, and (b) the quality of the proposed remediation plan to the RPC and Associate Dean, PGME.
10.2.4 The final remediation plan must be approved by the RPC and signed by the Program Director and resident.
10.2.5 A copy of the signed remediation plan must be forwarded to the PGME office.
10.2.6 The RPC will review all relevant documentation to determine the outcome of a remediation period (pass/fail).
10.2.7 The Associate Dean, PGME must be advised of the outcome of the remediation.
10.3 During a remediation, any leaves of absence and all holiday requests must be approved by the Program Director.
10.4 Upon the successful completion of a remediation, the resident will be given academic credit and will continue in the residency program out of phase.
10.5 A failed remediation period shall require the resident to proceed to a probation period.
10. 6 A resident may be remediated only twice during his/her residency, if identified as in need of remediation a third time he/she shall be placed on probation.
10.7 A resident who fails a remediation after a previous probation will be required to withdraw.
11.1 A probationary period is designed to assess specific aspects of resident performance.
11.2 A resident will be placed on probation for any of the following reasons:
11.2.1 A failed remediation period.
11.2.2 Identified for the third time as in need of remediation.
11.2.3 Upon recommendation of the RPC and/or the Program Director for any reason pertaining to academic progress or clinical skills which is unsatisfactory, or any serious issues relating to professionalism or absence from the program.
11.2.4 Upon recommendation of the Associate Dean, PGME, for any reason pertaining to academic progress or clinical skills which is unsatisfactory, or any serious issues relating to professionalism or absence from the program.
11.3 A Probation plan must address all of the following elements (see Schedule B for Probation Template):
- Identified areas of weakness requiring probation and assessment strategies that will be used to document performance
- The location and duration of the probationary program
- Expected outcomes of the probationary program
- Consequences of the successful completion or failure of the probationary program
11.3.1 The draft probation plan is developed by the Program Director in consultation with the RPC and reviewed with the resident.
11.3.2 The Associate Dean, PGME must be advised when a resident is placed on probation and a copy of the draft probationary plan and complete resident file forwarded to the PGME office for review by the EAB.
11.3.3 The PGME office must advise hospital administration and The College of Physicians and Surgeon of Ontario when a resident is placed on probation.
11.3.4 The EAB will review the complete resident file and forward recommendations relating to (a) the process by which the need for probation was determined, and (b) the quality of the proposed probationary plan to the RPC and Associate Dean, PGME.
11.3.5 The final version of probationary plan must be approved by the RPC and signed by the Program Director and resident.
11.3.6 A copy of the final version of probationary plan must be forwarded to the PGME office.
11.3.7 The RPC will review all relevant documentation to determine the outcome of a probationary period (pass/fail).
11.3.8 The RPC must advise the Associate Dean, PGME of the outcome of the probation.
11.3.9 The PGME office must advise hospital administration and The College of Physicians and Surgeon of Ontario of the outcome of the probation.
11.4 Duration and progress in training
11.4.1 A resident may be on probation for a period of up to one academic year subsequent to the commencement of the probation.
11.4.2 The probationary period may or may not count towards the duration of training required for certification by the relevant credentialing College.
11.4.3 Continuation in the residency will depend upon successful completion of the probationary period.
11.5 Probationary Period
11.5.1 During a probationary period any leaves of absence and all holiday requests must be approved by the Program Director.
11.5.2 Subject to 11.5.3, the resident who successfully completes a probationary period will not be awarded academic credit for the successful probationary period and will continue in the residency program out of phase.
11.5.3 Under exceptional circumstances, the RPC may recommend that academic credit be awarded for a probationary period. This recommendation is subject to approval by the Associate Dean, PGME.
11.5.4 A failed probationary period shall require the resident to withdraw from Queen’s School of Medicine.
11.6 Further Probation during a residency
11.6.1 A resident may be placed on probation on only one occasion during his/her residency.
11.6.2 The requirement to withdraw applies even when a resident changes from one Program to another Program.
12.1.1 A Program Director may request of the Associate Dean that a resident be suspended when the following conditions are suspected:
- Patient care and/or safety are jeopardized,
- Substance abuse,
- Inappropriate patient/physician interactions,
- Unethical behaviour,
- Unprofessional conduct,
- Criminal activity.
12.1.2 The process for dealing with Suspensions arising due to criminal activity is detailed in the Faculty of Health Science Police Records Check Policy Document, available on-line at: http://meds.queensu.ca/postgraduate/policies/prc
12.2 If the Associate Dean, PGME is of the opinion that the circumstances so require, the Associate Dean, PGME will notify the resident that he/she is suspended with pay, pending an urgent investigation.
12.2.1 The PGME office must advise hospital administration and The College of Physicians and Surgeon of Ontario when a resident is suspended.
12.2.2 The Associate Dean, PGME convenes the Academic Review Board (ARB) to conduct an investigation which will include a review of the resident's academic record, interviews with anyone with information relevant to the investigation, a meeting with the Program Director and Resident to discuss the concerns.
12.2.3 The ARB reports the finding of its investigation and its recommendation(s) regarding the resident's on going status in the program to the Associate Dean, PGME
12.2.4 The resident will be notified of the outcome of the investigation in writing, by the Associate Dean, PGME.
12.2.5 The PGME office must advise hospital administration and The College of Physicians and Surgeon of Ontario of the outcome of the investigation.
12.3 The Associate Dean, PGME will decide whether to:
- remove the suspension with or without conditions
- continue the suspension for a period of time with or without conditions
- recommend to the Dean that the resident be required to withdraw
12.4 The resident may appeal the decision of the Associate Dean, PGME to the Postgraduate Appeals Tribunal as a Level 3 appeal
13.0 Requirement to Withdraw
13.1 The events leading to a requirement to withdraw include:
13.1.1 A failed probationary period
13.1.2 A failed remediation after a previous probationary period
13.1.3 Failed AVP
13.1.4 Findings of behavior in which in the opinion of the Associate Dean, PGME:
- Patient care and safety are jeopardized,
- Substance abuse,
- There is inappropriate patient/physician interaction,
- There is unethical behaviour,
- There is unprofessional conduct,
- Criminal Activity.
13.2 The PGME office must advise hospital administration and The College of Physicians and Surgeon of Ontario, and either the Royal College of Physicians and Surgeons or the College of Family Physicians of Canada when a resident is required to withdraw.
14.0 Appeals Process
14.1 Appeals concerning the service component and other areas as outlined in the PARO-CAHO contract should be directed through the Professional Association of Residents of Ontario.
14.2.1 Avenues of appeal about academic decisions regarding the following situations:
- Unsatisfactory assessment (ITER)
- Repeat Rotation
- Annual Promotion
- Suspension in an urgent situation
- Requirement to withdraw
are described in 14.3 – 18.
14.3 The grounds of appeal must be based on extenuating circumstances or procedural flaws. Academic judgments are not subject to appeal.
14.4 Route for Academic Appeal
14.4.1 There will be an emphasis on informal resolution.
14.4.2 The route of appeal should be to the entity above the decision maker.
14.4.3 The following are the entities to whom appeals may be taken depending on the circumstances:
|Level 1||Residency Program Committee|
|Level 2||Associate Dean, PGME, or Delegate: Academic Review Board|
|Level 3||Dean, Faculty of Health Sciences, Queen's University or Delegate|
15.0 Notice of Appeal
15.1 In proceeding with any routes of appeal, notice of appeal must be given to the appropriate person or group in writing within 15 business days of the decision that is being appealed.
15.2 The recipient of the notice of appeal must respond in writing within 15 business days of the receipt of the notice of appeal.
16.0 Appeal Process at Level 1
16.1 Appeals from a requirement to repeat a rotation, complete a remediation or probationary period will be directed to the RPC.
16.2 The Level 1 appeal process will follow the guidelines attached as Schedule D.
16.3 The appeal will be heard in confidence by the RPC.
16.4 The resident may be accompanied by an advisor.
16.5 The RPC may grant or deny the appeal with or without conditions.
17.0 Appeal Process at Level 2
17.1 Upon the receipt of a written appeal from a resident from the decision of RPC, or a requirement to withdraw for academic reasons, the Associate Dean, PGME Postgraduate Medical Education will convene the Academic Review Board (ARB)
17.2 The Level 2 appeal process will follow the Rules of Procedure attached as Schedule E.
17.3 The appeal will be heard in confidence by the ARB.
17.4 The resident may be accompanied by an advisor.
17.5 The ARB makes a recommendation to the Associate Dean, PGME about whether to deny or grant the appeal with or without conditions. The Associate Dean makes the final decision.
18.0 Appeals Process at Level 3
18.1 A resident may submit a Level 3 appeal to the Dean, Faculty of Health Sciences, from a decision of the Associate Dean, PGME denying a Level 2 appeal or decisions of the Associate Dean, PGME described in 12.3 or 13.1.2. The resident must submit the appeal within 15 business daysafter being advised of the Level 2 decision or the decision of the Associate Dean, PGME.
18.2 The Dean shall arrange for a final hearing to be held in accordance with the Postgraduate Tribunal (the Tribunal) procedures. Attached as Schedule F are the rules governing a Level 3 appeal and the jurisdiction and composition of the Tribunal.
18.3 The Tribunal shall make one of the following decisions:
a. To grant the appeal in whole or in part, with or without conditions;
b. To deny the appeal
19.0 Access to Documents
19.1 At all levels of appeal, the decision makers will have access to the resident’s file, ITERS and other relevant documents and reports including without limitation:
The College of Physicians and Surgeons of Ontario-Licensing Standards
Royal College of Physicians and Surgeons of Canada-Standards of Accreditation