Learning from law cases: Exploring regulations on residents' (un)professional performance in postgraduate medical education

Fear and unfamiliarity with regulations governing assessment and dismissal of medical trainees may lead to suboptimal assessment decisions in post-graduate medical education, potentially compromising patient safety and quality of care. This thesis asks how program directors and teaching hospitals navigate these rules in education disputes, especially regarding residents deemed insufficient on their professional competencies.
The research blends literature on assessment and remediation in medical education with studies on the application of rules and regulations for postgraduate medical education, including mediation practices and labour law. It showed that residents in formal education disputes were previously assessed as insufficient in multiple CanMEDS competencies, including professionalism, communication, management and medical expertise. Residents’ insufficiencies in introspection were associated with insufficiencies in multiple competencies.
The research recommends that Dutch teaching hospitals improve their remediation and mediation procedures. Hospitals may apply evidence based strategies to improve the residents performance and prevail expertise and independence of the mediator during dismissal disputes. The thesis suggests that reflecting on law cases and education conflicts provides a rich source for educators, medical specialties, and teaching hospitals to improve their training programs and regulations.