DATE

NAME

ADDRESS

Re: Notice of Probation/Written Warning

Dear Dr. NAME

As discussed with you and NAME of PROGRAM DIRECTOR on DATE, this letter and the attached remediation plan will serve to further explain the terms of your probationary/written warning status. Your probation/warning will be effective DATE, and will last until DATE.

On the following DATES, you receivedinformal counseling from NAME OF PROGRAM DIRECTOR, which has been documented in your file. [INSERT DETAILS concerning informal counseling if applicable.] You received a written warning on [INSERT DATE]. [INSERT DETAILS OF WRITTEN WARNING.]You are now being placed on probationbecause your performance continues to be well below what is expected for a physician at your level of training. The probationary/written warning status isbased on [INSERT SPECIFICS]. Specifically, areas that require measurable major improvement include the following core competencies: [INSERT CORE COMPETENCIES NEEDING IMPROVEMENT].

In order to be removed from [probationary/written warning] status, you will need to show significant improvement in core competencies listed above commensurate to your PGY-[INSERT LEVEL]level, and it is your responsibility to satisfactorily complete all steps in the attached remediation plan. On DATE, we will reassess your performance and notify you whether your probationary/warning status has been lifted. If you fail to successfully meet the conditions of your probation/written warningand the attached remediation plan, [INSERT NEXT STEP e.g. you will be terminated, placed on probation, etc.].

Your remediation includes the following: INSERT REMEDIATION PLAN

1.

2.

3.

As per USF Graduate Medical Education policy, you have the right to appeal this decision. A copy of the GME Policy 218 is enclosed. You have 14 days from receipt of this letter to appeal this probation decision by filing a written appeal with the Chair of the department, [INSERT NAME of Department Chair]. [Use only if Probation –no appeal of written warning].

Your signature on this letter acknowledges receipt of this notice and the accompanying remediation plan.

Sincerely,

PROGRAM DIRECTOR

Director, [DEPARTMENT] Residency Program

Enclosure

Cc:[NAME]

Resident Advocateor mentor [if applicable]

Charles Paidas, MD

Associate Dean, Graduate Medical Education

______

Signature (RESIDENT NAME) Date