Grievances Between Residents and Their Training Programs. JAMA. 1999;281(4):379. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-4-jrf80041
The AMA-RPS receives inquiries from residents engaged in disputes with
their training programs and with questions about grievance procedures.
The AMA's Council on Ethical and Judicial Affairs has 2 ethical
opinions on these topics.
The basic principles of a fair and objective hearing should
always be accorded to the physician or medical student whose
professional conduct is being reviewed. The fundamental aspects of a
fair hearing are a listing of specific charges, adequate notice of the
right of a hearing, the opportunity to be present and to rebut the
evidence, and the opportunity to present a defense. These principles
apply when the hearing body is a medical society tribunal, medical
staff committee, or other similar body composed of peers. The
composition of committees sitting in judgment of medical students,
residents, or fellows should include a significant number of persons at
a similar level of training.
These principles of fair play apply in all disciplinary hearings and in
any other type of hearing in which the reputation, professional status,
or livelihood of the physician or medical student may be negatively
All physicians and medical students should observe these
safeguards when serving on a committee that will pass judgment on a
peer. All medical societies and institutions are urged to review their
constitutions and bylaws and/or policies to make sure that these
instruments provide for such procedural safeguards. (Issued prior to
April 1977; Updated June 1994.)
Clear policies for handling complaints from medical
students, resident physicians, and other staff should be established
and should include adequate provisions for protecting the
confidentiality of complainants. Confidentiality should be protected
when it does not hinder the subject's ability to respond to the
complaint. Access to employment and evaluation files should be
carefully monitored to remove the possibility of tampering. Resident
physicians should be permitted access to their employment files and
also the right to copy the contents thereof, within the provisions of
applicable federal and state laws.
Medical students, resident physicians, and other staff should
refuse to participate in patient care ordered by their supervisors in
cases in which the orders reflect serious errors in clinical or ethical
judgment, or physician impairment, that could result in a threat of
imminent harm to the patient or to others. In these rare cases, the
complainant may refuse to provide the care ordered by the supervisor,
if that will not threaten the patient's immediate welfare. The
complainant should communicate his or her concerns to the physician
issuing the orders and, if necessary, to those mediating such disputes.
Mechanisms for resolving these disputes immediately should be in place.
Third-party mediators of such disputes may include the chief of staff
or the involved service, the chief resident, a designated member of the
institutional grievance committee, or, in large institutions, an
institutional ombudsperson outside of the hospital staff hierarchy.
Retaliatory or punitive actions against those who raise complaints are
a legitimate cause for filing a grievance with the appropriate
institutional committee. (Issued June 1994 based on the
report1 issued December 1993.)