What Consequences Should Result from Failure to Meet Internal Standards?

Summary

This paper tries to approach a difficult problem, namely how to deal with a resident who has failed to meet the internal standards of a residency training program. First the problems of the definition of a standard and the associated problems of its reproducibility, documentation, teaching, update, and internal variability inside the same teaching program are dealt with. Consequently the question needs to be answered that constitutes a failure to meet the standard. The results of a survey of residents’ attitudes are quoted as are some responses to a survey among the chiefs of teaching programs. Considering the attitudes of residents on how to handle breaches of standard the basic message was that residents want to be told that they do not function. Both parties want the collaboration of senior staff members on this topic. Whereas residents want to re-train, exercise and talk they do not want sanctions. Chiefs, however, want much less re-training, exercising and talking but earlier sanction. The difficult point of dealing with a true failure is discussed in the light of the German legal situation and the actual possibilities of how to handle the case. Before it comes to the point of discontinuing the training of a resident, it needs to be agreed upon what would be a classical situation of failure in which both the chiefs responsible for training and the residents agree that training is better discontinued. The author describes his experience with the real course of events in 7 cases he witnessed in 22 years.