Dutch dismissal practices: characteristics, consequences, and contrasts in residents’ case law in community-based practice versus hospital-based specialties

Table 3 Characteristics potentially relevant to the programme director’s decision to dismiss a resident from training

	Community	Hospital	*p < 0.05 (test)
Confirmation of dismissal decision by conciliation board	29 (83%)	21 (60%)	0.034* (X²)
Gender = Male	21 (60%)	13 (37%)	0.056 (X²)
Years of training (mean) at dismissal	2.01	2.17	0.594 (t-test)
No deficient CanMEDS (mean)	3.4	3.1	0.289 (t-test)
Professional	31 (89%)	18 (51%)	0.001* (Fisher)
Communicator	27 (77%)	22 (63%)	0.192 (X²)
Manager	18 (51%)	22 (63%)	0.334 (X²)
Medical Expert	23 (66%)	28 (80%)	0.179 (X²)
Remediation plan
Formal	14 (40%)	21 (60%)	0.094 (X²)
Other forms	20 (57%)	10 (29%)	0.016* (X²)
Reasons to dismiss the resident
Untrainable	34 (97%)	35 (100%)	0.314 (X²)
Compelling reasons	9 (26%)	6 (17%)	0.382 (X²)
Mediation
Unfeasible	6 (17%)	16 (46%)	0.010* (X²)
Mediator	29 (83%)	2 (6%)	< 0.01* (Fisher)
Second opinion	1 (3%)	4 (11%)	0.356 (Fisher)
Other characteristics, technicalities and violated procedures
Premature dismissal	11 (31%)	10 (29%)	0.794 (X²)
Lacking documentation about severity of deficiencies	1 (3%)	8 (23%)	0.028* (Fisher)
Unclarity of the remediation plan	1 (3%)	3 (9%)	0.614 (Fisher)
Lack of residents’ guidance	3 (9%)	9 (26%)	0.062 (Fisher)
Resident temporarily on sick leave	14 (40%)	13 (37%)	0.806 (X²)
Claiming an unsafe educational climate	1 (3%)	9 (26%)	0.013* (Fisher)
Dissenting opinions in the training staff concerning dismissal	4 (12%)	2 (6%)	0.673 (Fisher)

Legend: This table shows a comparison of the frequencies of characteristics of law cases of dismissed residents from community-based practice and hospital-bases specialties. Frequencies were tested with X² or Fisher-exact or student test, depending on the frequencies < 5 and type of variables (binary or continuous). A formal remediation plan was a timed intervention of 3 to 6 months as specified in the Dutch residency training rules. We distinguished several technicalities evidenced by the conciliation board in their considerations or dictum, such as when a program director decided to dismiss a resident at a premature time, lacked sufficient and coherent documentation about feedback given to the resident about the severity of deficiencies, lacked a clear plan or outline for a remediation approach (without specific goals, conditions, methods or tools about what the resident should improve), lacked clear conditions or actual guidance for the resident. Moreover, an unsafe educational climate means a claim made by the resident that the working- or learning climate at the institution or training program was considered psychologically unsafe. Such a claim could be agreed on by the program director and/or evidenced by the conciliation board in their considerations or dictum

ISSN: 1472-6920