Intervention Levels for Programs to Address Identified Gaps

The ILP is a written academic planning and tracking tool, developed by the trainee in conjunction with program leadership for academic progress, at the beginning of each program year with program leadership or a mentor; for ACGME programs, this is a common program requirement (V.A.1.d).(3).  

Goals

• Map out a thoughtful program of study leading to proficiency for graduation, including “reach goals” to encourage development toward career aspirations

• Track and provide accountability for progress on goals to leverage strengths and focus on areas for improvement identified by mentors/advisors and the Clinical Competency Committee (CCC), including adding criteria in areas where sufficient progress is not being made.  The ILP can be modified at any time to reflect these needed criteria to keep the trainee on the right path. (See an expanded ILP.)  Areas for improvement brought forward in the ILP are considered an integral part of the growth process and a normal occurrence in training.  

• Allow trainees to customize their learning opportunities (elective/educational selections, experiences both in and out of their program) to support attainment of goals aiding career aspirations

Typical process for completing the ILP

• Before the 6 month review by the CCC, the trainee completes the self-reflection portion of the ILP.

• The Clinical Competency Committee does their 6 month review of the trainee.

• The Program Director shares feedback from the CCC that the trainee incorporates into their next ILP.

Goals for an expanded Individualized Learning Plan

• Addresses the greatest academic deficit and provides support to address gaps in performance; involves the trainee in choosing the steps most likely to close the gaps

• Sets time limits to accomplish the closing of the gaps

• Provides constructive feedback and encouragement to overcome deficiencies

• Emphasizes the correction of the problem while maintaining the trainee’s dignity and respect

• Spells out the consequences should the trainee fail in their attempts to address academic deficiencies

• Utilize formative feedback to the trainee on focus areas

• Allows the trainee to remain in good standing and continue active participation in the program while addressing concerns identified in this plan

• NOTE:  Neither the placement on, nor the failure of this plan is grievable under the Grievance Policy.

Triggers for Action at this level

• Failure to make progress with an issue identified in the Individualized Learning Plan that if it continues, would limit the success of the trainee in the program.  (See Potential Areas of Focus for an expanded ILP)

• When your learner is behind for their level of training (CCC evaluation of deficits in milestone progress or failure of an in-training exam or rotation)

• Problematic issues that impact patient care, work relationships/disrespectful communications, professionalism deficits, or academic success

Template:  Individualized Learning Plan 

Case study examples of how expanded individualized learning plans can be utilized for addressing gaps 

Probation

Probation is action to remedy academic performance deficiencies, if not addressed, may lead to dismissal.  Probation gives the trainee a set amount of time to correct their deficiencies defined in the probation letter in order to resume in the program in good standing. If deficiencies do not improve during this time frame, the program will need to make the decision if a longer probation period is appropriate or if the trainee should be dismissed.  This action becomes part of a trainee's permanent training record.

Goals

• Addresses ongoing and/or significant academic deficiencies and provide support to address gaps in performance

• Sets time limits to accomplish the closing of the gaps

• Spells out the consequences should the trainee fail in their attempts to address deficiencies

• Utilize formative feedback to the trainee on focus areas

Triggers for Action at this level

• Failure to make progress in an expanded Individualized Learning Plan in the specified timeframe.

Discipline Based on Misconduct

Goals

• Addresses an incident(s) of misconduct

• When applicable, sets time limits and/or identifies steps that must be taken to address concerns and facilitate a return to good standing

• Spells out the consequences should the trainee fail in their attempts to address the misconduct

Triggers for Action at this level -- when Discipline may be imposed (as determined by the Program Director and/or Associate Dean for GME):

Discipline is imposed for conduct that violates University, Medical School, GME, or Program policy, but does not reflect or implicate academic performance, or otherwise fall into the academic category.  Examples of non-academic misconduct include, but are not limited to:

• Drug or alcohol abuse

• Conviction of a crime.  Conviction includes the entry of a plea of guilty or nolo contendere.  It may also include the imposition of a deferred sentence, depending on the circumstances. 

• Engaging in a sexual or romantic relationship with a patient

• Falsifying patient records or other records

• Conscious disregard of safety rules

• Intentional violations of the Health Insurance Portability and Accountability Act (HIPAA)

• Having been found to have engaged in sexual misconduct or harassment

• Having been found to have engaged in scientific misconduct

• Having been found to have engaged in acts of workplace violence

Dismissal/Termination

This involves a written notice of immediate and permanent removal of the trainee by the Program Director from the educational program and the trainee's contract for failing to maintain academic and/or other professional standards required to progress or complete the program.  This becomes part of the trainee's permanent training record.  

Triggers for Action (see official policy for Discipline, Dismissal, and Failure to Advance)

• When conditions of probation/expected progress have not been met:

Decisions for dismissal for academic reasons are made by the Program Director, typically after a recommendation by the Clinical  Competency Committee of the program.

• Serious egregious actions

Decisions for dismissal for non-academic reasons (ex. policy violations, sexual misconduct, conviction of a felony, intentional violations of HIPPA) are made by the Department Chair, typically in consultation with the Program Director, the Associate Dean for GME, and program HR.

Failure to Advance

This is a written notice of intent not to advance a trainee to the next year of training.  The trainee must be given notice at least 4 months before the end of the program year. 

Triggers for Action

• Trainee has not progressed to a sufficient level on the milestones for the next year of training as determined by the Clinical Competency Committee.

Options for Programs

• Dismissal from the program

• Defer advancement pending successful outcomes of an improvement plan with a possible extension of training.  (Note:  The 4 month advance warning is not in effect in this circumstance.)

• Repetition of the year of training with an improvement plan in place 

Resignation

Residents/fellows who wish to resign before completing their training program must give at least a 30 day notice unless an exception is made by the Program Director, who must notify the Associate Dean for GME in writing.  Notice must be given in writing to the Program Director.  All conditions of appointment will terminate on the effective date of the resignation. 

Termination Resignation Agreement (Separation Agreement from the U of M)

A Termination Resignation Agreement can be offered only after the program decides to terminate based on adequate grounds.  The Office of General Counsel negotiates settlement with trainee’s counsel or Student Dispute Center advocate.  Usual terms: trainee resigns, agree on academic credit, file decisions, credentialing statement, recommendation, and release.