Probation Template

June 23, 20XX

John Doe, M.D.

1 Audubon Place

New Orleans, LA 70XXX

Dear:

Proposed Action:

After carefully reviewing your nurse, resident, and student evaluations and discussing your portfolio with a committee of XXXXXX faculty,  the XXX Program is placing you on probation for this academic year effective July 1, 20XX.

List of Deficiencies / Reasons:

This recommendation for probation is  based on the recommendations of the XXXX committee due to your substandard performances in the following competencies:

1. Patient Care: 
   1. Weak XXXXX (specialty) knowledge as demonstrated by your substandard in service exam scores both in July 20XX and February 20XX compromising patient care,
   2. inability to apply your knowledge for both teaching students and interns, and for providing  sound patient care.  Examples of this include:
      1. XXXX
      2. XXXX
      3. XXXX
   3. Lack of attention to detail compromising patient care. Examples of this include:
      1. XXXX
      2. XXXX
      3. XXXX
   4. Poor organizational and time-management skills reflected in:
      1.  Inability to write timely and accurate orders. Examples of this include:
         1. XXXX
         2. XXXX
      2. Execute the staff and resident’s therapeutic plans causing the supervisory residents to do much of your work.  Examples of this include:
         1. XXXX
         2. XXXX
      3.  Inability to work effectively as a team player . Examples of this include:
         1. XXXX
         2. XXXX
   5. Failure to consistently follow through on orders that you were specifically instructed to complete on your patients. Examples of this include:
      1. Failure  to look up the doses . This was seen :
         1. XXXX
         2. XXXX
   6. Use of incorrect or deliberately approximate dosing in critical situations. Examples of this include:
      1. XXXX
      2. XXXX
   7. Failure to follow a specific order on a medicine. Examples of this include:
      1. XXXX Rocephin
2. Medical Knowledge:
   
   1. Weak  XXSPECIALTYXX  medical knowledge evidenced by
      1. Poor performance on  pediatric in-service exams in July 2009 and February 2010
      2. Overall clinical performance on XXXX ward month in October 2009 and the XXXX team wards in June 2010.
      3.  Lack of insight into areas of weakness as evidenced by comments made about your performance by peers and supervisory residents on “check out “rounds and other rounds where you are directly observed. Specific examples of this include:
         1. XXX
         2. XXXX
         3. XXXX
3. Interpersonal Skills/Communication Skills: 
   1. Disrespectful, condescending behavior with fellows, residents, and students. Examples include
      1.  XXXX
      2. XXXX
      3. XXXX
   2. When questioned about the behavior you rationalized this behavior as a defense mechanism used for survival.  Specific examples of this include:
      1. XXXX
      2. XXXX
      3. XXXX
   3. Continued disrespectful behavior after counseling by myself and others. This was specifically sees:
      1.  XXXX
      2. Lack of insight into your behaviors and performance level as reflected above as reflected in the following examples:
      3. XXXX
      4. XXXX
   4. Rude and abrasive behavior with patients, families and peers as evidenced by
   5. Several peers  strongly dislike working with you because of your failure to adequately and consistently complete the tasks assigned to you. Examples of this include:
      1. XXXX
      2. XXXX
      3. XXXX
4. Professionalism: 
   1. Rude and disrespectful behavior . Examples include
      1. XXXX
      2. XXXX
      3. XXXX
   2. Inability of your peers to trust you . Examples include
      1. XXXX
      2. XXXX
      3. XXXX
   3. Untruthful behavior. Examples include:
      1. XXXX
      2. XXXX
      3. XXXX
         
         Your cavalier, overconfident behavior without the essential knowledge base is a dangerous combination that many residents feel will result in poor outcome for patients if you are not heavily supervised at all times.
         
         
5. Practice-Based Learning: 
   1. Failure to read assigned materials as seen :
      1. XXXX
      2. XXXX Web MD, XXXXX etc
   2. Failure to recognize, reflect on and correct mistakes despite being specifically counseled. Examples of this include
      1. Xxxx
      2. XXXX

Remediation Plan:

1. You will remain an intern in XXSPECIALTYXX until promoted
2. You must score XX% on In Service Exam
3. You must complete the on line review module on XXXX and by the following date
4. You will be assigned a mentor with whom to meet each week. Failure to make that meeting may result in immediate termination
5. You must present XX papers at journal club
6. You will be referred to Campus Assistance for evaluation/assessment of your “fitness for duty.”  You will be required to fulfill all of their requirements. 
7. You must demonstrate a graded improvement in your performances on both XXXXXXXX 360 evaluations.  Below average evaluations in any of the 6 competencies will result in termination.
8. You must attend 90% of all conferences unless excused by the Chief Residents or the Program Director. Failure to comply will result in immediate termination.
9. You must meet with the Program Director at least bimonthly.  YOU should initiate the meetings when convenient for your schedule.

Duration of Probation:

The length of the probation will be no longer than 3 months ending on or before XXXXXXXXX.

Consequences of unsuccessful Remediation:

Failure to comply with the requirements above may result in extension of the probation or non-promotion or  immediate termination. 

Appeal Process:

Should you desire to appeal this probation, you must follow the Due Process procedure outlined in the LSU House Officer Policy and Procedure Manual under Probation.

Sincerely,

Jane Doe

Program Director