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Resident Physician Forum
January 27, 1999

Grievances Between Residents and Their Training Programs

JAMA. 1999;281(4):379. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-4-jrf80041
Prepared by Ashish Bajaj, AMA Department of Resident Physician Services.

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.

Ethical Opinion 9.05: Due Process

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 impacted.

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.)

Ethical Opinion 9.055: Disputes Between Medical Supervisors and Trainees

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.)

AMA Council on Ethical and Judicial Affairs.  Disputes between medical supervisors and trainees.  JAMA.1994;272:1861-1865.