Abstract
Abstract
Background
Program directors and resident advisors serving as both evaluators and advocates for struggling residents face documented role conflict and rater bias, and Clinical Competency Committees (CCCs) tasked with collective remediation decisions face significant time and resource burdens. This study describes and evaluates the Directed Education Committee (DEC), a delegated CCC subcommittee developed to support residents with academic or clinical struggles through individualized education plans (IEPs), using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
Methods
This retrospective, mixed-methods study evaluated DEC over its first five years (Academic Year 2018–2023) at a family medicine residency program. Content analysis of faculty and CCC meeting minutes, using relational content analysis and cognitive mapping, assessed role delineation, cognitive dissonance, learner perception, resident-faculty relationships, and legal/compliance considerations before and after DEC implementation. Quantitative data on resident demographics and outcomes were analyzed using Chi-square and Fisher's exact tests, with significance set at α < 0.05.
Results
Over the study period, DEC supported 15 of 37 total residents (38% utilization), developing more than 50 IEPs comprising approximately 500 learning objectives. Only 3 residents (20%) experienced an adverse action (formal remediation, probation, or unsuccessful graduation); the remaining residents achieved competency in their identified area of struggle. No statistically significant associations were found between DEC enrollment, successful IEP completion, or adverse action and resident gender or race. Faculty focus group data indicated that DEC's structural separation of evaluator, advocate, and content-expert roles reduced role confusion and distributed legal/documentation risk compared to traditional program director- or advisor-led approaches.
Conclusions
DEC offers a structurally distinct, feasible alternative to traditional resident remediation models by formally separating evaluation, advocacy, and content-expertise functions within a delegated CCC subcommittee. This approach may be adaptable to other residency programs seeking to formalize support for struggling residents.