How Does the ABP Follow My Progress?
As part of the ABP tracking and evaluation program, your program director is asked to indicate annually whether your performance is satisfactory, marginal, or unsatisfactory in clinical competence and satisfactory or unsatisfactory in professionalism.
If your performance rating is satisfactory in both areas, the ABP will give credit for the year evaluated (e.g., R-1 year).
If a rating is marginal in clinical competence, your program director is asked to complete an individual evaluation form indicating the your level of performance and status in the program. You are requested to sign this form, which is then returned to the ABP.
If you receive an unsatisfactory rating at the end of the first year, you may be terminated from the program or given the option to repeat the R-1 year. (The same is true for your R-2 year if you receive an unsatisfactory evaluation.)
If you are completing combined training (e.g., combined internal medicine-pediatrics), a marginal or unsatisfactory evaluation in one of the two specialties will result in a marginal or unsatisfactory evaluation for the entire year of combined training.
If you receive a marginal evaluation, you must begin a remediation program developed by your program director. If your program director believes that it is appropriate to grant full credit for the year of training, they may mark you as "marginal with advancement to the next level," and you will be advanced to the next level. If more time is needed to make an evaluation for the year of training, an interim evaluation, "marginal with extension at the same level," may be marked, and an anticipated end date for the training level must be given. When you complete the extended period of training and the level of training is completed, a final evaluation for that level of training will be recorded. When "marginal with extension at the same level" is indicated, there must be an extension of training beyond the usual three years. Decisions regarding promotions are made by the program directors, not the ABP, and depend on the nature and importance of the deficiencies.
If you receive marginal ratings for two consecutive years of training (e.g., R-1 and R-2), you will not receive credit for the second marginal year and must repeat that entire year of training. If you receive a marginal rating for one training year (e.g., R-2) and receive a satisfactory rating for the following training year (e.g., R-3), then you receive credit for both years of training.
If you receive an unsatisfactory rating for professionalism in any year of training, you may either need to repeat the year or, at the ABP's discretion your the program director's recommendation, may be required to undergo a period of observation before eligibility to apply for the certifying exam is determined. If you are rated as satisfactory at the completion of the next year of training during which the period of observation will occur, you may receive credit for the year in question. The final year of training must be completed satisfactorily. You must receive satisfactory evaluations in all six components of competence to be eligible to apply for the certifying exam.
The table below illustrates the consequences of receiving an unsatisfactory or marginal evaluation in clinical competence.
The tracking system also identifies residents who transfer from one program to another or those who transfer to a new specialty and ensures that the new program director recognizes those residents who need remediation. Summary evaluations and credit granted will be sent to a new training program if you transfer. Your new program director and your previous program director must communicate to discuss previous clinical experiences, evaluations, and remediation. Your new program director will be responsible for continuing a remediation program, if necessary, ensuring that all training requirements have been met, and for evaluating you when you apply for certification.
Throughout the course of training, you should receive feedback and appropriate remediation to address and correct identified problems. Residents with problems have the responsibility to work with their program directors in the development and implementation of an appropriate remediation program.
Although your program director has the primary responsibility for keeping residents informed about their evaluations, you also have the responsibility of keeping yourself informed about your individual evaluations by requesting feedback if it is not given by your program director.
The ABP believes that this system of evaluation will benefit you by identifying problems early so that remedial measures can be initiated promptly. Both verbal and written feedback are vital to education and continuing professional growth.
At least twice a year, your program director or their designee should meet with you to review your progress in the program. It is also your responsibility to take every opportunity to ask your program director, attending faculty, and chief resident for an assessment of your performance.
How May I Appeal Adverse Judgments?
The ACGME requires for program accreditation that trainees be provided due process. Residents who wish to appeal evaluations or final recommendations by the program director must proceed through institutional due process mechanisms.
What If I Want to Change Programs?
Sometimes trainees desire a change in programs. Reasons for transfer to a different program are multiple and may include dissatisfaction with the current program, a change in specialty or subspecialty interest of the resident or fellow, change in desired location of training (e.g., spouse relocation, family illness), and desire to transfer to a program more suitable to the resident's goals. Decisions about changing programs should be discussed with the program director in time to permit the program to seek a suitable replacement. Summary evaluations will be sent to your new training program if you transfer. Trainees should be aware that interruptions in residency of more than 24 continuous months require review and approval by the Credentials Committee of the ABP.
It is the primary responsibility of the program director to complete and send the annual evaluation summary to the ABP. It is suggested that the training program director obtain the resident's consent to do so. It is the responsibility of the program director to obtain consent from trainees to report summary evaluations, credit, and other training information to the ABP.
Acknowledgment: The American Board of Pediatrics wishes to thank the American Board of Internal Medicine for its assistance and for permission to use parts of its booklet, Residents: Evaluating Your Clinical Competence in Internal Medicine, in the production of this document.