Fired

[DAKAZA]

I'm a PGY 2 anesthesia resident and I was recently notified that my contract will not be renewed in January (started off cycle). This is due to some poor OR evaluations. My ITE and AKT scores were good. Anyway, my program is encouraging me to pursue another specialty but I don't even know where to start. I would greatly appreciate any general advice. Thanks.

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[caligas]

They did you a favor. Look at Family Medicine with a fellowship in something useful like womens health, palliative care, sports medicine.

 

[Noyac]

Heed their words.

 

[GeorgiaAnes]

Sorry to hear the news. There was one resident where I trained who was asked to look elsewhere. She ended up going FP. No idea how that worked out for her but anesthesia was clearly not the place for her.

I agree with others, look at FP or IM. If you're really not good with people, then Path (I hear it is more competitive though). Good luck.

 

[repititionition]

I'm sorry. That sucks, emotionally if nothing else. Why or how did you start off-cycle?

 

[gascopper]

perhaps you can ask them what specifically the evaluations said?

 

[Planktonmd]

This is probably the best thing that ever happened to you... a few years from now you will be happy that they did you this huge favor and got you out of this dead specialty.

 

[Consigliere]

Truly a blessing in disguise, kid. Dust yourself off, get over it, and apply broadly to IM. Shine. Get a GI or cards fellowship. Be employable. Anesthesiology is dead, man.

 

[Consigliere]

This may have had something to do with it...

http://forums.studentdoctor.net/threads/failed-cs-twice-us-graduate.1013727/

 

[deleted171991]

Even if anesthesia were God's greatest gift to humanity, when a residency program fires a resident after the second year, they are usually right: the resident is just not cut out for anesthesia.

 

[aimedicine]

What makes one not suitable for anesthesia? This question is more for the attendings on this forum, what are some of the things you would see and say ok this guy is not cut out for anesthesia

 

[FollowTheMoney]

Even if anesthesia were God's greatest gift to humanity, when a residency program fires a resident after the second year, they are usually right: the resident is just not cut out for anesthesia.

A PGY-2 is a CA-1.... this is his/her first year in anesthesia right?

 

[amyl]

Talk to your residency program. They are experienced producing anesthesiologists. They did you a favor to tell you this early on. perhaps they will help you find a spot in another specialty. my residency program would do this for people they thought were not cut out for anesthesia.

 

[caligas]

This may have had something to do with it...

http://forums.studentdoctor.net/threads/failed-cs-twice-us-graduate.1013727/

Good catch

 

[Consigliere]

What makes one not suitable for anesthesia? This question is more for the attendings on this forum, what are some of the things you would see and say ok this guy is not cut out for anesthesia

1) You've got a spine
2) You've got a personality
3) You LOVE medicine

 

[pgg]

What makes one not suitable for anesthesia? This question is more for the attendings on this forum, what are some of the things you would see and say ok this guy is not cut out for anesthesia

That's a vague subject with lots of correct answers, not many of which are going to be helpful to you. If I had to distill it to one sentence, it would be:

People who routinely get in trouble, when they didn't see trouble coming, are not cut out for anesthesia.



Anecdotally, and very very generally speaking, I think former athletes, or people who performed/competed at something (anything) in their prior-to-medicine lives, tend to not have this problem. I think it's because the same kind of character traits that make good competitors - lack of stage fright, performance under pressure, performance when outcomes matter right now, ability to adapt to external events - also make situationally-aware anesthesiologists.

 

[Carbocation1]

Isn't residency supposed to teach one the skills to become a good anesthesiologist, along with individual effort? Relative to other specialties, are there many young folks in gas who are simply not cut out for it?

 

[FollowTheMoney]

Isn't residency supposed to teach one the skills to become a good anesthesiologist, along with individual effort? Relative to other specialties, are there many young folks in gas who are simply not cut out for it?

Not when you are at a malignant second rate program...

 

[deleted171991]

What makes one not suitable for anesthesia? This question is more for the attendings on this forum, what are some of the things you would see and say ok this guy is not cut out for anesthesia

Some things that you'd want to see in an anesthesiologist:
- easily/instantly likeable and friendly personality
- fast-thinker and doer
- good communicator
- very adaptable
- wide and deep medical knowledge, especially of physiology, pharmacology and internal medicine
- good with his/her hands
- calm in even the most stressful situations.

One has to either have (at least) these traits (maybe 20% of us, who become the rock stars), or develop ways to cope and compensate for the missing ones (my and many others' case). One just can't compensate for a bunch of these, and that's when it's time for a career switch.

Not being cut out for anesthesia is nothing to be ashamed of. Most surgeons are not cut out for internal medicine, and the other way round. Long-term, a physician will be much happier/successful in a specialty that suits his/her personality. The sooner one finds it the better.

 

[deleted171991]

1) You've got a spine
2) You've got a personality
3) You LOVE medicine

Well-said.

 

[urge]

Go into IM.

Isn't residency supposed to teach one the skills to become a good anesthesiologist, along with individual effort? Relative to other specialties, are there many young folks in gas who are simply not cut out for it?

It is not for everyone. You have to be able to be organized with minimal time to do so, deal with multiple dysfuctional personalities, be able to react quickly during emergencies, and do it all in a pleasant manner.

I find that people who are typically slow have the hardest time with residency.

 

[IlDestriero]

The guy that left our program after CA2 went into PM&R.
More his speed.

 

[lobelsteve]

The guy that left our program after CA2 went into PM&R.
More his speed.

Watch, he will go into pain and make millions in private practice. And never had to work hard or deal with surgeons 1 to 1.

 

[bashwell]

Anecdotally, and very very generally speaking, I think former athletes, or people who performed/competed at something (anything) in their prior-to-medicine lives, tend to not have this problem.

Does this include chess club? Just kidding.

 

[Twiggidy]

Go into Rads, do Nighthawk, and live somewhere fun abroad (London, Paris, Byron Bay Aus <----that one's for @bashwell )

 

[Planktonmd]

That's a vague subject with lots of correct answers, not many of which are going to be helpful to you. If I had to distill it to one sentence, it would be:

People who routinely get in trouble, when they didn't see trouble coming, are not cut out for anesthesia.

If this were true then half the anesthesiologists and all the CRNAs are not cut for anesthesia!

 

[Planktonmd]

Isn't residency supposed to teach one the skills to become a good anesthesiologist, along with individual effort? Relative to other specialties, are there many young folks in gas who are simply not cut out for it?

No... they want people who score well on the exams, do what they are told and know when to shut up!

 

[Planktonmd]

Some things that you'd want to see in an anesthesiologist:
- easily/instantly likeable and friendly personality
- fast-thinker and doer
- good communicator
- very adaptable
- wide and deep medical knowledge, especially of physiology, pharmacology and internal medicine
- good with his/her hands
- calm in even the most stressful situations.

One has to either have (at least) these traits (maybe 20% of us, who become the rock stars), or develop ways to cope and compensate for the missing ones (my and many others' case). One just can't compensate for a bunch of these, and that's when it's time for a career switch.

Not being cut out for anesthesia is nothing to be ashamed of. Most surgeons are not cut out for internal medicine, and the other way round. Long-term, a physician will be much happier/successful in a specialty that suits his/her personality. The sooner one finds it the better.

By the way I know many practicing surgeons who have no business being surgeons!

 

[Depakote]

What makes one not suitable for anesthesia? This question is more for the attendings on this forum, what are some of the things you would see and say ok this guy is not cut out for anesthesia

Common sense is vital. Unfortunately it's something that can't be taught... you either have it or you don't.

 

[Twiggidy]

No... they want people who score well on the exams, do what they are told and know when to shut up!

This all day...

I survived because of the last two. I did terrible on ITE and I would blame all my attendings for "lack of teaching". It wasn't until I realized that because they covered multiple rooms that the time to babysit a resident wasn't there. If you didn't read a book or pay attention the first time you were taught something you weren't going to learn it.

Now having said that, I always thought that short of literally murdering a patients (i.e. intention) it was pretty difficult to fire a resident, but I guess if someone is really THAT dangerous in the OR a program won't take chances. Again, I wasn't the smartest dude in my class but I was careful, listened, and did what I was told.

 

[caligas]

I did some caddying in high school and the 3 rules were:

Show up
Shut up
Keep up

You could do worse than to follow those as a resident.

 

[Crayola227]

I did some caddying in high school and the 3 rules were:

Show up
Shut up
Keep up

You could do worse than to follow those as a resident.

Yes, you can do worse.

I shouldn't be snarky, I don't even know what caddying is

 

[asmith1121]

I'm just a resident but it's pretty self righteous to say anesthesiologist should be great at basically everything, and that as a pgy2, if he doesn't have all of them, he deserves to be fired. It's so annoying how unsupportive we are of each other, people are always criticizing each other in the lounge for poor outcomes-and they would have done it better. It is most def true that we are responsible for knowing basically everything in medicine...but as a 2, are you really suppose to know it all and be calm in every situation? The only person to get fired in my program was dangerous in the OR bc he didn't care or pay attention, and was all around lazy and avoiding work

 

[pjl]

There are people who clearly are not meant to be anesthesiologists. One of the best residents at my program according to tests was so dangerous in the OR that he was supervised 1:1 for 6 months of failed remediation, prior to having a place made in the IM department where he shined. He was oblivious to the fine detail changes and when issues occurred he just plain could not act. Many attempts were made and a variety of teaching methods failed, he just wasn't going to make it.

 

[Doctor4Life1769]

I'm just a resident but it's pretty self righteous to say anesthesiologist should be great at basically everything, and that as a pgy2, if he doesn't have all of them, he deserves to be fired. It's so annoying how unsupportive we are of each other, people are always criticizing each other in the lounge for poor outcomes-and they would have done it better. It is most def true that we are responsible for knowing basically everything in medicine...but as a 2, are you really suppose to know it all and be calm in every situation? The only person to get fired in my program was dangerous in the OR bc he didn't care or pay attention, and was all around lazy and avoiding work

Some people (faculty) don't belong in academia.

 

[Giic]

That's a vague subject with lots of correct answers, not many of which are going to be helpful to you. If I had to distill it to one sentence, it would be:

People who routinely get in trouble, when they didn't see trouble coming, are not cut out for anesthesia.



Anecdotally, and very very generally speaking, I think former athletes, or people who performed/competed at something (anything) in their prior-to-medicine lives, tend to not have this problem. I think it's because the same kind of character traits that make good competitors - lack of stage fright, performance under pressure, performance when outcomes matter right now, ability to adapt to external events - also make situationally-aware anesthesiologists.

You're stretching it a little bit This is definitely an anecdote you posted. I've worked with a lot of good anesthesiologists who were not the most outspoken or competitive cookies in the box, but who were conscientious. I would argue that paying close attention to detail, conscientiousness, and the ability to work with difficult people are more important to becoming an anesthesiologist. It is very much like critical care.

 

[Giic]

Some things that you'd want to see in an anesthesiologist:
- easily/instantly likeable and friendly personality
- fast-thinker and doer
- good communicator
- very adaptable
- wide and deep medical knowledge, especially of physiology, pharmacology and internal medicine
- good with his/her hands
- calm in even the most stressful situations.

One has to either have (at least) these traits (maybe 20% of us, who become the rock stars), or develop ways to cope and compensate for the missing ones (my and many others' case). One just can't compensate for a bunch of these, and that's when it's time for a career switch.

Not being cut out for anesthesia is nothing to be ashamed of. Most surgeons are not cut out for internal medicine, and the other way round. Long-term, a physician will be much happier/successful in a specialty that suits his/her personality. The sooner one finds it the better.

I would argue that you didn't mention the single most important trait to being a good anesthesiologist: Attention to detail.
None of the things you mentioned would matter if you were not conscientious with minute detail, e.g. if you were careless or didn't notice trends early.

 

[chfo]

Situational awareness.

If you don't have it, you will fail.

Know your threats, have good intel, have basic plan of attack, be readily adaptable to rapidly changing conditions. Know your exit strategy. Know when you need help. Know how to help others. Be an expert with your equipment, know your limits. Cross train and become experienced in the practice of everyone around you. Keep your ears and your eyes open. Don't let complacency become your defeat.

Be a silent professional.

You are the Navy SEALs of the operating room.


Why did dakaza fail in the operating room?
Probably lacked situational awareness.

This is much more than attention to detail.

We've all known people who had fantastic attention to detail, but didn't know how to piece it all together.

Or, they fail because of target fixation. https://en.wikipedia.org/wiki/Target_fixation


More so than any other specialty in medicine, in anesthesia, you must have the magic mix of skills, knowledge, and personality. If you can't compensate for any deficiency, you will fail.

 

[leaverus]

oh please. while that may be true to some extent, Ive known enough colleagues who lack skills and/or personality. and I can recall more than a few of my attendings from residency who had zero personality. what does that even mean?

 

[bashwell]

oh please. while that may be true to some extent, Ive known enough colleagues who lack skills and/or personality. and I can recall more than a few of my attendings from residency who had zero personality. what does that even mean?

I tried to be normal once. Worst minute of my entire life.