The Feedback and Remediation Process: Optimizing Wellness and Supporting Learner Progression while Navigating the Evolving Landscape in CL Psychiatry

Abstract: Life-long learning as a driver of improved performance in practice is a core value for physicians, critical for establishing public accountability and trust, and an important component of the continuous certification process. Self-assessment and feedback are two methods of determining learning and performance, but establishing an effective ongoing practice for this can be difficult. This is particularly the case for professionalism, which lacks a universal definition and and is highly susceptible to assessment bias. A formal remediation or disciplinary process may be required when problematic behavior or competency deficiencies arise.



There is little empirical research that address the feedback or remediation process in psychiatry and the complexities remain fraught with challenges for program directors and clinical supervisors. Consultation-Liaison Psychiatry (CLP) is uniquely challenging in that there are a multitude of evaluative data sources and an often bewildering hidden curriculum that includes conflict management, limit-setting, negotiation of ownership and recognizing concealed motivations.



This session is designed to provide a structured approach for making the feedback and remediation process work effectively while containing the impact on fellow trainees and faculty. Following an overview of the process, we will discuss the assessment of learning gaps and role of structured feedback to support lifelong learner progression within CLP. Types and causes of deficiencies will be identified and strategies for developing individualized learning and remediation plans will be shared. The role of wellness, as contributor to competency concerns and as fallout of the feedback and remediation process will be explored and we will present an approach for simultaneously supporting wellness and addressing deficiencies. The workshop will additionally address common challenges, such as barriers to implementation and achieving a more equitable remediation process.

Dr. Ann Schwartz will provide an introduction to the trainee remediation and disciplinary process, from discovery to resolution, highlighting differences in approach and timeline between residency and fellowship programs and addressing potential barriers and pitfalls as well as collateral damage.

Dr. Thomas Heinrich will focus on identification and remediation of the struggling CLP faculty member, taking into consideration both individual and systemic factors contributing to perceived poor performance.

Dr. Carrie Ernst will discuss strategies for integrating mentorship, coaching, and a culture of self-assessment and lifelong learning so as to optimize wellness during the feedback and remediation process.

Dr. Caitlin McCarthy, a chief resident at the Medical College of Wisconsin, will address the effects of disciplinary actions on other trainees in a program and present approaches to manage the vulnerability and fear that may arise in the context of remediation or dismissal of a fellow trainee.



In the first breakout session, participants will work through case examples, discussing challenges in the feedback and remediation process. In the second breakout session, participants will conduct a self-reflection exercise and complete an individualized learning plan, identifying their strengths, gaps, and improvement goals.





References:



Cherr GS, Orrange SM, Berger RC. Remediation of the Struggling Clinical Educator. J Grad Med Educ. 2019;11:6-9.

Godschalx J, van Mook W. Dismissed Psychiatry Residents Who Appeal: Exploring Unprofessional Behavior. Academic Psychiatry 2023;47:344-351.



Content Contributors:

Diversity, Equity, and Inclusion: The session will in part explore systemic bias in remediation and disciplinary processes, as there is data to suggest both bias in definition and assessment of professionalism and disparities in placement on academic probation status. Additionally, our speaker panel reflects a diversity of experiences, geographic areas and roles, by including a current resident in addition to mid to later career faculty members from 3 different regions of the country. Faculty members hold leadership roles representing residency training, fellowship training and faculty/administration.