Summary This study examined how residency training programs apply mediation in disputes between residents and program directors. From January to May 2022, the centralized education committees of all seven Dutch university hospitals were approached with a survey. They responded by email, answering questions, sending documents, explaining by phone or online how they applied mediation in practice. From October 2024 to March 2024 the Dutch Organization for Residency Training in General Practice was questioned about how they applied assessment and mediation. Several respondents from Flanders (Belgium) were also included to qualitatively compare specialties and countries on mediation approaches in practice. Documents were received and an online interview was conducted with one of the seven Heads of General Practice Residency Training programs in the Netherlands. Confidentiality was guaranteed to all participants, meaning that information about outcomes and residents’ cases were described or disclosed without information that could reveal their identity or refer to their specialty or training institute. The themes discussed were goals and guidelines for mediation, persons involved, their profession, roles, responsibilities and relationship with the hospital or centralized educators committee, the number of disputes dealt with, and outcomes. Mediation goals include keeping track of the process, informing all parties about regulations, second opinions, (binding) advice, resident discouragement or remediation. The frequency of mediation by centralized education committees appears to be low, even less than once a year per committee. Hospitals may not have enough experience to develop specific expertise on mediation because of the low frequency of mediation per committee member. Therefore, we recommend concentrating on coordinating mediations in disputes and safeguard the mediator’s independence.

Data description (Qualitative Data) Questions Inquiry or Interview (see below) List of Respondents (separate document) List of Documents (separate document)

Questions about mediation in postgraduate medical education 1. Does your Centralized Education Committee have a protocol or guideline for applying mediation to disputes between residents and program directors? (If so, could you please send us the protocol to illustrate your procedures?) 2. Does your Centralized Education Committee work with an ad-hoc committee to facilitate mediation, and if so, a. Does this committee include members from the University Medical Center or an external party? b. How many persons are included in such a committee? c. Which persons are among these committee members? i. A resident? ii. An educationalist? iii. Members of the Centralized Education Board? d. What roles apply to this committee? e. Does the committee have insights on the resident’s portfolio? f. Are both parties heard applied adversarially, and how is this realized? g. Will the committee deliver concrete advice to the parties? If so, is this advice binding (such as a second opinion), or is the committee’s role more facilitating the process? 3. Does the Centralized Education Board make use of an externa mediator? 4. How often did the Centralized Education Board Mediate between a program director and a resident regarding a dispute on training termination between 2011 and 2020? 5. What were the outcomes of mediation by the Centralized Education Committee? a. Intensified Supervision Trajectory? b. Training continuation in another hospital? c. Inadmissible? 6. How often did the resident choose to continue the procedure at the conciliation board?