Hello,
My spouse has been placed in a performance plan at the end of the first year and not promoted to 2nd year. The primary reason given was that she lied to an attending that she checked her patient while she actually had not. (She had not lied, but was not able to answer exactly the attending's question as to what the urine ouput was etc.. when she had checked, so he is assuming that she lied). Also, there was mention that she had a bossy attitude etc.. (That one was from the left field).
She was already under observation at that time, as she some how offended one of the powerful attendings in the program.
For the last 6 months since this started, she has been working really hard. Got some great evals (A commendation letter from an attending). But, the PD is now saying that what you did 4 months back(lying) was a professional issue and it is out of my hands and you may be terminated by the committe.
What are our options: Should we take legal help, Should we quit before they fire us. She feels targetted and has been very brave and faced a lot.
PS: I am writing this as my wife is too distraught to do much of this and I am trying to help her.
First, take a look at a previous thread about probation and termination
here.
The first issue is whether this is an academically appropriate termination, or a malicious action of a program director. From the outside, it is impossible to distinguish them. Several details suggest that this is warranted -- she was on "observation", presumably for poor performance, and then has continued to have performance issues over a reasonable period of time (6 months).
The "lying" you refer to may seem benign to an outside observer. What probably happened was something like this: The attending asked your wife what the patient's urine output was. She answered "it was OK" or "normal" or gave a volume. The attending checked the record and in fact found out that the patient had a poor (or copious) urine output. This is one of the intern cardinal sins, and is not tolerated. If she didn't know, she should have said so -- I'm sure they would have faulted her for that also, but not knowing is much better than making something up. If she confused two patients, that's understandable also but also a huge problem. Even if this is completely off the mark, the fact remains that most PD's will only terminate a resident for a pattern of performance problems -- replacing terminated residents is a huge pain.
One good evaluation from an attending does not cancel out poor evaluations. When I have a resident on a remediation/probation plan, we stress that we need to see a persisitant pattern of improvement in all clinical venues and by all evaluators to proceed.
Her current trouble is likely not related to the "lying" incident 4 months ago per se, but is likely that plus a lack of sufficient improvement over the last 4 months.
There are some inherent unfairness issues in situations like this:
- Residents under observation are scrutinized, and all small errors are detected. Other residents may be making similar errors, but no one notices.
- The alternative is a problem also: residents who are in remediation plans where the faculty are kept "blinded" often complain that they don't get enough feedback to improve. If I'm working with someone for 2 weeks and I'm not told of the issues in advance, it might take me the first week to collect enough experience to realize there is a problem and try to address it.
- The rumor mill starts, at all levels: faculty, residents, nurses, etc. This only worsens the situation.
- Some residents start to "feel the pressure to perform" which can worsen their performance.
- Program Directors are clearly in charge, and there is little residents can do to challenge their decisions.
What can you do?
First of all, the fact that you are here asking these questions because she is "too distraught" to do this is a huge red flag. This is her problem to solve. Your role should be in moral support.
The difference between resigning / being terminated is rather small. Any program which considers her after this will want to know the details. There may be some financial or visa issues to address, although you can usually not collect unemployment if you are terminated for cause.
Each GME program must have an internal appeal process. The PD or the director of GME should be able to explain this to her, and it's probably in the "housestaff manual" which every program has. She can appeal her decision internally, for which there really are only two arguments: 1) the termination is capricious / vindicitive / without cause; or 2) the program did not follow it's own internal rules for termination. Other than these two issues, the PD has full latitude around assessing competence.
External legal options are extremely limited, and are state dependent. You can certainly review this with a lawyer.
Finding a new program will likely be her best option. There is no easy way to do so. She could apply in the match for a new PGY-1 position (and plan to repeat her entire PGY-1). As it sounds like her current program is unwilling to promote her to a PGY-2, this may be her only option. She can of course try to get an offcycle PGY-1 spot outside the match. Her PD may be willing to help her find a new spot, and perhaps she should consider a new field. Residents who do not do well in IM/FP might consider pathology and/or psych where skills are very different.
Good luck. You have a bumpy road ahead.
!
