Traditional Poster Round
Context: : Remediation of poorly performing medical professionals is challenging. When the practitioner is not meeting clinical objectives, the possibility for error increases, frustration builds, patient safety may be compromised. However, methods to identify struggling practitioners and strategies for remediation deficits are not well defined or studied.
Description: : We developed a simulation based remediation program addressing individual needs of the practitioner. The program assesses learner’s competence, addresses deficiencies and develops an individualized learning plan incorporating deliberate practice, feedback, and reflection. Referrals are made by the pediatric residency program or unit based nurse educators. Candidates meet with simulation educators and review program guidelines. The candidate’s needs are evaluated and a cognitive stacking activity is performed having candidates organize and reorganize their daily activities according to changing priorities during the shift. The activity allows educators to design individual sessions to meet the learner’s needs. If deficiencies related to unprofessional behavior, externalization of responsibility, physical/mental disabilities or English language difficulties are identified, candidates are referred to appropriate resources. Once accepted into the program, regular sessions occur. Length of the program varies on individual need and content is learner-driven. Scenarios include organization, critical thinking, time management, prioritization, and deteriorating patient conditions. Lack of confidence is often identified in participants and is addressed in all sessions. Frequent communication between the learner, the referral base and the simulation educator is essential to relay progress and address evolving performance challenges.
Observation/Evaluation: : We have assisted 15 medical professionals including registered nurses and pediatric residents. Thirteen (87%), successfully completed the program and continued to have careers at our institution and beyond. Two resigned from the institution before completing the program. Participants have expressed personal and professional satisfaction with the program and referral bases have been extremely satisfied with post remediation performance and report direct improvements in patient care.
Discussion: : Remediation will continue to be necessary with the complexities of care, new knowledge and advancing technology. Simulation based remediation provides a safe, effective, and promising tool to assist struggling medical professionals.