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Academic Improvement Policy

I. Purpose of Policy

The purpose of this policy is to establish non-disciplinary academic improvement procedures for all Graduate Medical Education (GME) training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) to follow if a resident fails to meet academic expectations.

II. Policy Scope

This policy applies to all Accreditation Council for Graduate Medical Education (ACGME)-accredited residency and fellowship programs at Dartmouth-Hitchcock (D-H).

III. Definitions

Resident: Any physician in an accredited graduate medical education program, including interns, residents, and fellows.


Designated Institutional Official: The individual in a sponsoring institution who has the authority and responsibility for all of the ACGME-accredited GME programs.


Academic Deficiency: The Resident is not meeting one or more of the ACGME Core Competencies, as revised from time to time, which may include: patient care and procedural skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and system-based practice.

Examples of academic deficiencies include, but are not limited to:

  1. Issues involving knowledge, skills, job performance or scholarship;
  2. Failure to achieve acceptable exam scores within the time limits identified by the training program;
  3. Unprofessional conduct;
  4. Professional incompetence, including conduct that could prove detrimental to D-H’s patients, employees, staff, volunteers, visitors or operations.

IV. Policy Statement

  1. Non-Disciplinary Measures for Academic Improvement
    • Program Directors are encouraged to confer with the Clinical Competency Committee and/or the Designated Institutional Official (DIO) in making determinations as to the existence of an Academic Deficiency and the appropriate course of action. Depending on the nature of the Academic Deficiency, Disciplinary Action, pursuant to the Disciplinary Action Policy, may be indicated, rather than the non-disciplinary, remedial measures set forth below.
    • GME Program Directors are encouraged to use the following measures to resolve Academic Deficiencies. These measures are designed to give notice to the Resident of deficiency and to identify strategies to address the deficiency. The Program Director has discretion to use any of the measures below based on evaluation of all facts and circumstances, and such measures need not be used in a particular order. These remedial actions do not constitute Disciplinary Action as defined in the Disciplinary Action Policy. These non-disciplinary remedial measures are not subject to review or appeal under the General Grievances Policy or the Appeal of Disciplinary Action Policy.

  2. Informal Conversation
    • An Informal Conversation (sometimes referred to as an “awareness conversation”) may be undertaken by the Program Director to address a Resident’s Academic Deficiency of a nonserious nature that needs to be remedied or improved. The purpose of an Informal Conversation is to describe the Academic Deficiency and to recommend actions to rectify the deficiency. After a Program Director has conducted the Informal Conversation with the Resident, the Program Director may summarize the discussion in writing and provide the Resident with a copy of the summary. The summary should include a succinct statement of the Academic Deficiency and the steps recommended to rectify the deficiency.
    • This non-disciplinary action need not follow nor precede a Notice of Concern or a Remediation Plan, nor precede Disciplinary Action as described in the Disciplinary Action Policy. Failure to achieve immediate and/or sustained improvement may lead to Disciplinary Action or implementation of additional measures as set forth below. Any future action will be determined by the Program Director exercising his/her professional and academic judgment.

  3. Notice of Concern
    • A Notice of Concern may be issued by the Program Director to a Resident who is not performing satisfactorily. Notices of Concern should be in writing and should describe the nature of the Academic Deficiency and any necessary corrective actions required by the Resident. A Notice of Concern is typically used when a pattern, or potential pattern, of Academic Deficiency emerges. The Program Director will review the Notice of Concern with the Resident. Failure to achieve immediate and/or sustained improvement may lead to a remedial plan, as set forth below, or Disciplinary Action.
    • This non-disciplinary action need not follow nor precede an Informal Conversation or a Remediation Plan, nor precede Disciplinary Action as described in the Disciplinary Action Policy. Program Directors are encouraged to consult with Employee Relations in drafting the Notice of Concern.

  4. Remediation Plan
    • A Remediation Plan may be provided to a Resident who has demonstrated an Academic Deficiency, the underlying causes for which the Program Director, in his/her professional judgment, believes are amenable to remediation. A Remediation Plan must utilize the standard Graduate Medical Education (GME) template, and must be in writing. The Remediation Plan is designed to give the Resident notice of the Academic Deficiency (ies) identified and set out specific expectations of how to address deficiencies. Where possible and appropriate, the Program Director will seek the Resident’s input to elicit his/her judgment of how to best address the deficiencies. The Program Director will review the Remediation Plan with the Resident. Failure to achieve immediate and/or sustained improvement or a repetition of the conduct may lead to additional Remediation Plans or Disciplinary Action.
    • A Remediation Plan does not constitute a Disciplinary Action and need not follow nor precede an Informal Conversation or a Notice of Concern, nor precede Disciplinary Action as described in the Disciplinary Action Policy. Program Directors are encouraged to consult with Employee Relations in drafting Remediation Plans and must alert the GME Office prior to issuance of the Remediation Plan to the Resident.
    • Copies of written summaries of Informal Conversations, Notices of Concern, and Remediation Plans will be maintained in the Resident’s file in the GME Office.

  • Reporting to the New Hampshire Board of Medicine
    • Under New Hampshire law, certain actions involving physician discipline or adverse action must be reported to the Board of Medicine. The remedial measures and actions set forth above do not need to be reported to the Board of Medicine unless there was gross or repeated negligence by the Resident which resulted in the harm of a patient.
    • It is noted that disciplinary action such as probation, suspension, dismissal or nonreappointment pursuant to the Disciplinary Action Policy, where such action results from a Resident who fails to meet the goals of a Remediation Plan, is reportable. In addition, behavior incompatible with the role of a physician including illegal, immoral or unethical behavior must also be reported to the Board of Medicine. The DIO is designated as the D-H representative who will make required reports in connection with GME matters to the New Hampshire Board of Medicine. The DIO is encouraged to consult with the Office of General Counsel in instances where a report may be required.


    D-H Policy ID: 11321

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