Dutch dismissal practices: characteristics, consequences, and contrasts in residents’ case law in community-based practice versus hospital-based specialties
Abstract Background In the Netherlands, 2 to 10% of the residents terminate training prematurely. Infrequently, termination of training is by dismissal. Incidentally, residents may disagree, dispute and challenge these decisions from the programme directors. Resident dismissal is always a difficult...
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | BMC Medical Education |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12909-024-05106-w |
| _version_ | 1797274268672720896 |
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| author | Judith Godschalx-Dekker Walther van Mook |
| author_facet | Judith Godschalx-Dekker Walther van Mook |
| author_sort | Judith Godschalx-Dekker |
| collection | DOAJ |
| description | Abstract Background In the Netherlands, 2 to 10% of the residents terminate training prematurely. Infrequently, termination of training is by dismissal. Incidentally, residents may disagree, dispute and challenge these decisions from the programme directors. Resident dismissal is always a difficult decision, most commonly made after, repeated assessments, and triangulation of the resulting assessment data and one or more remediation attempts. Nevertheless, the underlying reasons for dismissal and the policies for remediation and dismissal may differ between training programmes. Such differences may however impact the chance of remediation success, the chance of dismissal and subsequent residents’ appeals. Method We included a total of 70 residents from two groups (community-based and hospital-based specialties) during 10 years of appeals. Subsequently, we compared these groups on factors potentially associated with the outcome of the conciliation board decision regarding the residents’ dismissal. We focused herein on remediation strategies applied, and reasons reported to dismiss residents. Results In both groups, the most alleged reason to dismiss residents was lack of trainability, > 97%. This was related to deficiencies in professionalism in community-based practice and medical expertise in hospital-based specialties respectively. A reason less frequently mentioned was endangerment of patient care, < 26%. However, none of these residents accused of endangerment, actually jeopardized the patients’ health, probably due to the vigilance of their supervisors. Remediation strategies varied between the two groups, whereas hospital-based specialties preferred formal remediation plans in contrast to community-based practice. A multitude of remediation strategies per competency (medical expertise, professionalism, communication, management) were applied and described in these law cases. Discussion Residents’ appeals in community-based practice were significantly less likely to succeed compared to hospital-based specialties. Hypothesised explanatory factors underlying these differences include community-based practices’ more prominent attention to the longitudinal assessment of professionalism, the presence of regular quarterly progress meetings, precise documentation of deficiencies, and discretion over the timing of dismissal in contrast to dismissal in the hospital-based specialties which is only formally possible during scheduled formal summative assessment meetings. |
| first_indexed | 2024-03-07T14:55:58Z |
| format | Article |
| id | doaj.art-f377b155896149558ba902bb737508bf |
| institution | Directory Open Access Journal |
| issn | 1472-6920 |
| language | English |
| last_indexed | 2024-03-07T14:55:58Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Education |
| spelling | doaj.art-f377b155896149558ba902bb737508bf2024-03-05T19:27:01ZengBMCBMC Medical Education1472-69202024-02-0124111010.1186/s12909-024-05106-wDutch dismissal practices: characteristics, consequences, and contrasts in residents’ case law in community-based practice versus hospital-based specialtiesJudith Godschalx-Dekker0Walther van Mook1Department of Psychiatry and Medical Psychology, GGZ Central, FlevoziekenhuisDepartment of Intensive Care Medicine, Academy for Postgraduate Training, Maastricht UMC+, and School of Health Professions Education, Maastricht UniversityAbstract Background In the Netherlands, 2 to 10% of the residents terminate training prematurely. Infrequently, termination of training is by dismissal. Incidentally, residents may disagree, dispute and challenge these decisions from the programme directors. Resident dismissal is always a difficult decision, most commonly made after, repeated assessments, and triangulation of the resulting assessment data and one or more remediation attempts. Nevertheless, the underlying reasons for dismissal and the policies for remediation and dismissal may differ between training programmes. Such differences may however impact the chance of remediation success, the chance of dismissal and subsequent residents’ appeals. Method We included a total of 70 residents from two groups (community-based and hospital-based specialties) during 10 years of appeals. Subsequently, we compared these groups on factors potentially associated with the outcome of the conciliation board decision regarding the residents’ dismissal. We focused herein on remediation strategies applied, and reasons reported to dismiss residents. Results In both groups, the most alleged reason to dismiss residents was lack of trainability, > 97%. This was related to deficiencies in professionalism in community-based practice and medical expertise in hospital-based specialties respectively. A reason less frequently mentioned was endangerment of patient care, < 26%. However, none of these residents accused of endangerment, actually jeopardized the patients’ health, probably due to the vigilance of their supervisors. Remediation strategies varied between the two groups, whereas hospital-based specialties preferred formal remediation plans in contrast to community-based practice. A multitude of remediation strategies per competency (medical expertise, professionalism, communication, management) were applied and described in these law cases. Discussion Residents’ appeals in community-based practice were significantly less likely to succeed compared to hospital-based specialties. Hypothesised explanatory factors underlying these differences include community-based practices’ more prominent attention to the longitudinal assessment of professionalism, the presence of regular quarterly progress meetings, precise documentation of deficiencies, and discretion over the timing of dismissal in contrast to dismissal in the hospital-based specialties which is only formally possible during scheduled formal summative assessment meetings.https://doi.org/10.1186/s12909-024-05106-wAptitudeAssessmentCanMEDSDismissalProceduresRemediation |
| spellingShingle | Judith Godschalx-Dekker Walther van Mook Dutch dismissal practices: characteristics, consequences, and contrasts in residents’ case law in community-based practice versus hospital-based specialties BMC Medical Education Aptitude Assessment CanMEDS Dismissal Procedures Remediation |
| title | Dutch dismissal practices: characteristics, consequences, and contrasts in residents’ case law in community-based practice versus hospital-based specialties |
| title_full | Dutch dismissal practices: characteristics, consequences, and contrasts in residents’ case law in community-based practice versus hospital-based specialties |
| title_fullStr | Dutch dismissal practices: characteristics, consequences, and contrasts in residents’ case law in community-based practice versus hospital-based specialties |
| title_full_unstemmed | Dutch dismissal practices: characteristics, consequences, and contrasts in residents’ case law in community-based practice versus hospital-based specialties |
| title_short | Dutch dismissal practices: characteristics, consequences, and contrasts in residents’ case law in community-based practice versus hospital-based specialties |
| title_sort | dutch dismissal practices characteristics consequences and contrasts in residents case law in community based practice versus hospital based specialties |
| topic | Aptitude Assessment CanMEDS Dismissal Procedures Remediation |
| url | https://doi.org/10.1186/s12909-024-05106-w |
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