Policy of the Graduate Medical Education Committee
Section: Institutional Responsibilities
Subject: Evaluation and Promotion
Number: 1.300
Date Developed: 1/89
Last Review/Revision: 12/05
Replaces: previous policy of same name, dated 11/02
ACGME Requirement: Institutional II.D.4.d & III.B.6 &7; Common V

Purpose
To describe the policy and procedures pertaining to evaluation and promotion of residents (includes fellows).

Definitions
Promotion is advancement based on merit to a higher rank or title.  Failure to perform at an acceptable level in the period of current appointment means that an individual will not be promoted.

Non-promotion means that the resident fails to perform at an acceptable level in the period of current appointment or cannot reasonably function satisfactorily at the next level and is not advanced to a higher rank or title.  A non-promotion does not necessarily mean either non-reappointment or dismissal, but merely that the resident will not be advanced to the next level of appointment at the completion of the contract period.  

Non-reappointment means that a resident is not offered a next successive contract for appointment at the end of the current appointment period (usually June 30).  Non-reappointment is not a dismissal as governed by GME Committee Policy 1.420 and, therefore, does not require cause.

Policy
The evaluation and promotion of residents is the responsibility of each Program Director and Departmental Chairperson.  Each Program Director must establish and implement formal written criteria and processes for the evaluation and promotion of residents according to the procedure below.  Faculty members and attending physicians evaluate the resident to determine progressive scholarship and professional growth in order to support increased responsibility of patient care.  In some cases, other professional health care staff, peers and medical students also evaluate residents.

The Program Director must notify the Associate Dean for GME if he/she intends to non-reappoint or non-promote a resident.  The Program Director must notify the resident of the decision to non-promote or non-reappoint by a written notice at least four months prior (usually March 1) to the expiration of the current period of appointment, regardless of PGY level of the resident. However, if the primary reason(s) for the non-reappointment occur(s) within the four months prior to the end of the current appointment, the resident will be provided with as much written notice of the intent not to renew as the circumstances will reasonably allow, prior to the expiration of the current period of appointment. A resident involved in non-reappointment or non-promotion has a right to appeal according to the GMEC Policy, 1.410, Adjudication of Resident Grievances.

The GMEC, through its internal review process, will monitor each program’s written policies, procedures and guidelines for evaluation and promotion of its residents.

Evaluation Plan
Each residency program (includes fellowships) must have an effective plan for assessing resident performance throughout the program and for utilizing the results to improve resident performance. This plan should include:

1. The use of methods that produce an accurate assessment of residents' competence in patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice,
2. Mechanisms for providing regular and timely performance feedback to residents that includes at least  written semiannual evaluation that is communicated to each resident in a timely manner,
3. A process involving use of assessment results to achieve progressive improvements in residents' competence and performance, 
4. The maintenance of a record of evaluation for each resident that is accessible to the resident.

Procedure
The Program Director, with participation of members of the teaching staff and Department Chair shall:
1.                  Communicate the written criteria and processes for evaluation and promotion to each resident;
2.                  Evaluate the knowledge, skills and professional growth of the residents, using appropriate written criteria and processes to
            determine advancement in the program.  The methods of evaluation used to assess the knowledge, skills and professional
            growth in to order to determine promotion may vary among the training programs;
3.                  Prepare a written semiannual evaluation, or more often as dictated by the residency review requirements; 
4.         Communicate each evaluation to the resident in a timely manner;
5.         Advance the resident to a position of higher responsibility on the basis of satisfactory progressive scholarship and professional growth;
6.         Maintain a permanent record of evaluation for each resident and have it accessible to the resident and other authorized personnel
             including the internal review panel;
7.         Provide a written, final evaluation for each resident who completes the program as part of the resident’s permanent record
            maintained by the department. The final evaluation must include a review of the resident's performance during the final period
            of education and should include the following statement signed by the program director: “I verify that the resident has
            demonstrated sufficient competence to enter practice without direct supervision."
8.        Notify the Associate Dean for GME if he/she intends to non-promote or non-reappoint a resident.
9.        Notify the resident of the decision to non-promote or non-reappoint by a written notice at least four months prior to the
            expiration of the current period of appointment unless the primary basis for such action occurs within the final four months
            of the current appointment.