What goes on your permanent record in residency?

[Mystiqz]

Does anybody know what does and doesn't go on your permanent record for residency? Does a letter of reprimand stay permanent or is it like a slap on the wrist? Thanks in advance.

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[hippiedoc13]

It's probably program-dependent. But I would hazard a guess that if they took the time to write an actual letter of reprimand, as opposed to just giving a verbal warning, then it probably stays in your file.

 

[mcl]

The ACGME has specific requirements for maintaining current files and past resident files as follows (from the August 2008 ACGME Bulletin)

Resident Files

The brief list below provides the expectations for the minimum content in current residents’ “educational files” maintained by the program:
-- written evaluations from the faculty and others;
-- periodic evaluations (at minimum every six months) by the Program Director, his/her designee and/or a resident evaluation committee;
-- records of resident physician’s rotations and other training experiences, including surgical and procedural training as applicable;
-- records of disciplinary actions, as pertinent to the given resident
-- for residents engaged in moonlighting, a prospective, written statement of permission from the program director (as specified by the institutional requirements);
-- materials required by ACGME institutional and special program requirements; and
-- other content as determined by the Program Director and/or the sponsoring institution.
-- for residents successfully completing the program, ...a succinct summary of the resident’s evaluations and/or a letter documenting the resident’s ability to practice competently and independently.

The term “files” in this context is not limited to paper formats. The resident files in a given program may be paper-based, retained in electronic storage or a combination of the two.

Document Retention

The following core files should be kept indefinitely by the sponsoring institution, to accommodate requests for primary source verification for residents who have completed the program:
-- a summation of the resident’s evaluations and/or the final letter by the program director;
-- records of resident physician’s rotations, training experiences and procedures; and
-- documentation of disciplinary action, if any.
-- for residents who do not complete the program or who are not recommended for Board certification, most programs will keep the entire file indefinitely in case of subsequent legal action.

 

[dragonfly99]

It depends on what the PD wants to put in there. He/she can put official or unofficial/temporary reprimands in there. Obviously you'll have your periodic evaluations in there as well.

 

[docB]

Do you mean permanent that will stay with you throughout residency or permanent that will stay with you forever?

If you mean permanent forever it would only be things that result in a lawsuit, dismissal or loss of priveledges, any money payout on your behalf (ie. going into the databank) or something that results in a board action. Getting a bad eval or the like won't matter after residency.

 

[mcl]

Do you mean permanent that will stay with you throughout residency or permanent that will stay with you forever?

If you mean permanent forever it would only be things that result in a lawsuit, dismissal or loss of priveledges, any money payout on your behalf (ie. going into the databank) or something that results in a board action. Getting a bad eval or the like won't matter after residency.

Bad rotation evaluations don't stay in the permanent (meaning post residency completion) file--there's just a list of rotations and a summary evaluation which must include a statement that you are competent for independent clinical practice. However, a record of any formal disciplinary action (and it's ultimate resolution) would remain in the permanent file. Honestly, it makes sense--licensing and credentialing boards will contact your residency program for verification throughout your career. Invariably, they want to know if any disciplinary action was taken during residency, so the permanent file needs to reflect this information.

This is an ACGME requirement, and they review random files of current and graduated residents during site visits to make sure appropriate records are being maintained.

 

[dragonfly99]

Yes, but there is a lot of leeway in terms of what program directors can do. There are some PD's who put a LOT of people on formal probation, which will go in their permanent files, and there are others who just put people on some sort of remediation/unofficial probation and then if resident does well, all is well in the end. There's a big difference between these 2 scenarios (for the resident).

 

[captaincrunch]

Hello,

The main reason to know if an incident/problem is on your "permanent record" is so that you know about it when applying for licensure/jobs. For example, if you indicate "no" when asked about any disciplinary problems on a license application and your program contradicts you, you could find yourself in trouble. Similarly, if you apply for a job, you will want to know what your program will say about you to your (potential) partners.

I think dragonfly is right; there are no hard and fast rules. Some PDs will list every demerit you received while others will keep these things out of your record (so long as you show improvement, of course). So what do do? If you have a concerning event in your residency, I would recommend that you *politely* ask your PD what he/she will say and how you should respond to the questions on an application. Of course, if you've never been in any kind of trouble, there isn't much to worry about.

Cheers!

 

[baconandeggs]

hope this post is not hijacking this thread...

If a resident was put on probation but
1) successfully completed remediation program
2) successfully completed residency program

but PD
3) put records of disciplinary actions in permanent file
4) summary letter in permanent file seemed to mostly document the incidents with only a small paragraph documenting the resident’s ability to practice competently and independently.

and subsequently, resident was honest & upfront and disclosed the above but
5) had difficulty looking for a job (maybe economy had a part too)
6) had difficulty getting fellowship due to probation
7) ULTIMATELY got into a fellowship program (yay!) in different state.

The current fellowship program has been very supportive and understanding (hence the successful credentialing) . But what does the future hold after successfully completing the current fellowship?

Will employers / future credentialing committees dwell on the residency record or will being successfully credentialed (the first time) have any positive impact in terms of looking for a future job? Thanks in advance!

 

[mcl]

Will employers / future credentialing committees dwell on the residency record or will being successfully credentialed (the first time) have any positive impact in terms of looking for a future job? Thanks in advance!

The farther you are from the events with no new incidents to report, the less impact the actions taken during residency will have. The word "resolved" carries a lot of weight. Most likely the first job/fellowship post residency will be the most difficult hurdle you'll face.

 

[baconandeggs]

MCL, thanks.

Interviews have started. Should the probation period be voluntarily brought up? I think it is preferable to be honest and upfront but at the same time will employers overlook the fact that residency was successfully completed and a fellowship was obtained (which requires successful credentialing)?

 

[mcl]

MCL, thanks.

Interviews have started. Should the probation period be voluntarily brought up? I think it is preferable to be honest and upfront but at the same time will employers overlook the fact that residency was successfully completed and a fellowship was obtained (which requires successful credentialing)?

I don't think it's relevant to a job interview unless you are asked a question about overcoming a difficult experience and choose to talk about it. Your residency certified you as being competent to practice (the ACGME requires that wording), and you didn't have any problems during your fellowship. Once you're offered the position, the question of probation might be part of the credentialing process, but you'll explain what happened and that the issue was resolved and your residency program will echo that in their residency verification paperwork. The practice or hospital hiring you will see the consistency and that will be that.

I've had three residents go on academic probation during my tenure in the department (14 yrs) and successfully remediate whatever deficiencies the faculty felt warranted the probation. All of them found positions when they graduated--two in private practice and one in academics.

Best of luck to you during your job search!

 

[baconandeggs]

Mcl, thank you for the advice and reassurance.