Section 10: Evaluations, Adverse Action and Due Process

Evaluations

Overview:

Being a board certified/eligible general Internist, a Pulmonary Critical Care Medicine Fellow is already equipped with a high level of clinical skills, including procedural abilities, interpersonal skills, and a strong foundation of medical knowledge. The additional wisdom accumulated during PCCM fellowship further enhances these skills, resulting in expertise in the areas of pulmonary diseases and Critical Care Medicine. The fellowship curriculum centers around the six core competencies: patient care, medical knowledge, practice-based learning and improvement, interpersonal skills and communication, professionalism, and systems-based practice.

Through evaluations, faculty members have an opportunity to assess the fellow’s skills, values, and attitudes beyond just a written test. The evaluation process also promotes self-assessment and career progression.

The system of evaluation is continuous and diverse, happening daily/weekly/monthly in different settings such as rounds, endoscopy suite, conferences, and while designing research projects.

The Program Director, Associate Program Director, or key faculty will deliver written and verbal feedback monthly, utilizing the competency-based form for PCCM fellows in New Innovations. The evaluation criteria for successful completion of rotation assignments will become incrementally challenging as the three-year fellowship progresses. The New Innovations tool will assess both cognitive and procedural skills.

Every six months, a formal evaluation session will take place using the semi-annual PCCM Fellow evaluation form. The PCCM Fellowship Education Training Committee will create these evaluations based on methods specified in sections A, B, and C below. The Program Director or Associate Program Director will then review the evaluations with you.

Every year, at least once, the standard Naval Officer Fitness Report or its equivalent will be filled as specified by the relevant BUPERS instructions.

The fellows will also evaluate the program and staff regularly. It is mandatory for fellows to evaluate our PCCM staff twice a year . Emphasis will be on staff effectiveness as educators and the program’s effectiveness in meeting your educational needs. The composite evaluations will support faculty in their professional development. The Annual Program Review will use program evaluations.

360-degree evaluations will also incorporate evaluations of fellows by peers, patients, nurses, and ancillary staff. Each fellow will perform a self-evaluation.

PCCM Program Directors Association conducts an annual “in-service” examination. Fellows use this exam as a self-assessment tool. This exam typically takes place in the spring.

Key faculty and fellows participate in the Annual Program Review each spring.

Evaluation Methods:

The fellow’s evaluation will include daily observations by the staff; monthly evaluation forms filled by staff on the New Innovations website; 360 evaluations; participation and preparation for journal club; written and verbal feedback post presentations; chart reviews; and regular meetings of the Pulmonary Key Faculty.

The program’s content, process, and trainees’ academic progress will be supervised by the PCCM Fellowship Education Committee, which includes the Program Director and Key Faculty. The Program Director will lead all meetings. The committee meets monthly. The committee, with representative fellows, will conduct an annual comprehensive program review (Program Annual Review) and update the Handbook/Curriculum as needed.

The PCCM Fellowship Committee will assess each fellow’s performance in ACGME core competencies, clinical competence, teaching abilities, performance in technical procedures, and progress in research projects/process improvement projects.

On a semi-annual basis, the PCCM committee will perform an extensive review of each fellow’s performance. Post this review, the Program Director will have an individual meeting with each fellow to discuss academic standing. A written record of this review will be added to the fellow’s training record.

Adverse Action and Due Process

Definitions:

Adverse Academic Action:

A formal, reportable change in academic standing, such as probation, suspension (which may or may not be an adverse academic action depending on specifics like HRAFT vs. ARAFT leading to probation/termination), or termination of training. These actions require Graduate Medical Education Committee (GMEC) review and are documented using DHA Form 165.

Program-Level Remediation:

Actions such as counseling or in-program remediation plans for failure to meet educational goals, which are managed at the program level and are not typically considered adverse academic actions unless escalated.

Clinical Competency Committee (CCC):

A committee of three or more faculty members that advises the Program Director on resident/fellow progress and may recommend advancement, remediation, or adverse academic actions.

Probation:

An adverse academic action recommended by the PD, in consultation with the CCC, when a trainee’s deficiencies (academic, clinical, or disciplinary) are such that, if not corrected, will likely result in failure to complete the program. It can follow unsuccessful program-level remediation or a single egregious incident. If a fellow is placed on probation, there will be an ad-hoc Clinical Competency Committee meeting, and a mentor will be assigned with mandatory periodic meetings.

Suspension:

A period when a trainee remains in the program but is not actively training or progressing. This can be a Health-Related Absence from Training (HRAFT), which is non-adverse, or an Administrative-Related Absence from Training (ARAFT). An ARAFT becomes a formal, reportable suspension if it results from an investigation leading to an approved adverse academic action like probation or termination.

Termination:

The removal of a trainee from the program prior to completion due to grievous events, persistent performance issues, ethical concerns, safety violations, or failure to promote.

Process for Adverse Academic Actions:

  1. Adverse academic actions typically begin with the fellowship Clinical Competency Committee (CCC) reviewing the trainee’s record and making a recommendation to the Program Director (PD) regarding deficiencies linked to ACGME competencies.
  2. Except for egregious events, the PD will usually implement program-level remediation before proposing a formal adverse action. The PD must meet with the trainee, provide written notification of any proposed adverse academic action (clarifying its reportable nature), and provide a copy of the current GMEC Policy for Resident/Fellow Adverse Academic Action and Due Process. The trainee has up to five business days to respond.
  3. If the PD concurs with a CCC recommendation for an adverse academic action, the PD submits a formal proposal to the Chair of the GMEC Subcommittee for Resident Performance. The trainee will also meet with the DIO prior to the subcommittee hearing.
  4. The GMEC Subcommittee for Resident Performance reviews the proposal. The trainee has the right to be present (physically or virtually, except during deliberations) and provide a written or oral statement. The proposal must detail deficiencies, ACGME competency-based expectations for improvement, consequences if goals are not met, and a timeline.
  5. For probation, if approved by the subcommittee, the trainee’s progress is monitored monthly by the GMEC. Decisions for probation by the subcommittee are final. If probation conditions are unmet, the PD may propose further probation or termination.
  6. For termination proposals approved by the subcommittee, the recommendation is forwarded to the DIO for endorsement and then to the MTF Director for final approval.
  7. Trainees may appeal termination decisions of the GMEC Subcommittee to the DIO. A secondary review may be performed by the DIO or a delegated hearing. The final disposition is forwarded to the MTF Director for approval.

References and Appendices

  • Section 10 Appendix 1: NMCSD GMEC Resident Grievance Policy (21 January 2024)
  • Section 10 Appendix 2: NMCSD GMEC Resident/Fellow Adverse Academic Actions and Due Process (21 January 2025)
  • Section 10 Appendix 3: NMCSD GMEC Faculty and Resident Professionalism Policy (09 April 2025)
  • Section 10 Appendix 4: Resident/Fellow Professionalism Contract (23 June 2023)