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RemediationMethodsforMilestonesRelatedto InterpersonalandCommunicationSkillsand Professionalism LindaRegan,MD BradenHexom,MD StevenNazario,MD SnehaA.Chinai,MD AnnetteVisconti,MD ChristineSullivan,MD Aprogramdirectorreceivesthefollowing complaintfrom2membersofthefaculty:a postgraduateyear(PGY)3residentseems argumentativeduringpatienthandoffsandisneither receptivetodiscussionsaboutpatientcareconcerns nortofeedbackabouttheirinteractions.Underthese circumstances,howshouldtheprogramdirector approachthisproblem,whichreßectsdeÞcienciesin interpersonalandcommunicationskills(ICS)and professionalismcompetencies?Whatremediation strategiesshouldbeconsideredandcanthemilestones guidetheremediation?Arethereanybestpractice recommendationsthatcanserveasatemplateacross specialtiesforprofessionalismandICSthatprogram directorscanusefortheirresidents? Aspartofthenewaccreditationsystem,the AccreditationCouncilforGraduateMedicalEduca- tiondevelopedtheMilestoneProject,whichincludes specialty-speciÞcsubcompetenciesandmilestones undereachofthe6competencies. 1Ð3Themilestones allowprogramstodeterminetheprogressionofeach residentÕsknowledge,skills,andattitudesduringthe courseoftraining. 4Withtheunderstandingthat subcompetenciesandmilestonesforcompetencies, suchaspatientcareandmedicalknowledge,might varysigniÞcantlyamongspecialties,weposedthe questionastowhetherornotthoseforICSand professionalismsharecommoncontentthemes.If unifyingstandardsforthehouseofmedicineforthese competenciesdidexist,itshouldfollowthatsuggest- edapproachestoremediationcouldbeapplicable acrossspecialties. ItistheauthorsÕhopethatthebestpractice recommendationstofollowwillallowaprogram directortoexpandhisorhertoolboxforremediation ofthesecompetencies,whilealsodevelopinga broaderunderstandingofapproachestosuccessful remediation.Inaddition,aremediationapproach usingtargetedstrategiesmappedtosubcompetency proÞciencylevelsispresentedfortheauthorsÕ specialtyofemergencymedicine(providedasonline supplementalmaterial). TheProblem DespitetheimportanceofprofessionalismandICS tothetrainingoffuturephysicians,residency programsoftenstrugglewitheducatingresidentsin theseareas,aswellasprovidingeffectiveremedia- tionforthosewhofailtomeetexpectations. 5Ð7 Ina survey,pediatricsprogramdirectorsreportedthat residentsterminatedafterfailedremediationwere signiÞcantlymorelikelytohavedeÞcienciesinICS andprofessionalism, 8whileneurologyprogram directorsnotedthatthemostprevalentissuefor ‘‘problemneurologyresidents ’’wasprofessionalism, asdemonstratedbyinappropriateinteractionswith colleaguesandstaff. 9Amongprogramdirectorsin emergencymedicine,80%notedthatdeÞcienciesin professionalismwerehardertoremediatethan deÞcienciesinothercorecompetencies. 10Clinical skillsexaminationscoresforCanadianmedical studentsshowedapredictiverelationshipbetween studentswhoscoredpoorlyoncommunicationand futurecomplaintsintheirmedicalpractice,with studentsinthebottomquartileaccountingfora signiÞcantlyhigherpercentageofpatientcom- plaints. 11Programdirectorsfacemultiplechallengesin strivingtoeffectsuccessfulremediationofresidents failingtomeetmilestoneachievements. 12While somespecialties(suchasemergencymedicine, radiology,pathology,andophthalmology) 1,3 list suggestedassessmentmethodsforthecompetencies, manyprovidenoguidancetoprogramdirectorswith DOI:http://dx.doi.org/10.4300/JGME-D-15-00060.1 Editor™sNote:Theonlineversionofthisarticlecontainsvignettesin emergencymedicine,familymedicine,obstetricsandgynecology, andpsychiatry,aswellasremediationapproachesbyproficiency levelforEmergencyMedicineInterpersonalandCommunication SkillsandProfessionalismMilestones. 18JournalofGraduateMedicalEducation,February1,2016 PERSPECTIVES
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