"Permission" to fast track

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Bearrie

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I was wondering on what grounds a program is "allowed" to refuse residents from fast tracking. My understanding is that the PD/RRC must upload ACGME milestones for each resident to ADS semi-annually? And that PDs must share milestone data at request of PDs at transferring program? At what level in each milestone must we be at time of applying? For the submission period that ends Jan 8, are second years supposed to be at or above 1.5 or 2 for each milestone?

Also, most CAP fellowships require LOR from current PD. Is this simply at the whim of the PD to decide is he or she will write a letter? Suppose a program have 6 residents and 4 want to fast-track, can the program simply refuse to allow some because they need PGY4s? Do they renew your contract and secure funding for PGY4 year and then transfer it to where you match or do they not renew your contract if you inform them you plan to fast-track.

Sorry for so many questions but this has been an issue of considerable concern at my program. Is it an issue anywhere else? Have you found your program generally supportive or more inclined to dissuade you and apply for fellowship after 4th year? Thanks so much!

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As I understand it, meeting the requirements to complete your general psych training falls on the CAP program that accepts you. From that standpoint, programs would not really need to release you. In fact, it has happened that fast tracking into child is a way for dissatisfied residents and PDs to part ways 1 year early. Since a lot of even good fellowships don't always fill their slots, the system promotes this happening. In some cases, programs would rather have a bad fellow than no fellow just to fill the coverage gaps.
 
the milestones have nothing to do with it though in general graduating residents are expected to meet level 4 milestones in most areas (but by no means all). but i would expect an intern to be at level 2 for most areas, there is no such a thing as 1.5 unless you averaging out a bunch of things but that would be really bad for a PGY-2. in fact in my curriculum we have PGY-1s expected to meet level 3 and even 4 milestones in particular areas for example: PBLI1 3.3.c "Critically appraises different types of research, including RCTs, systematic reviews, meta-analyses and practice guidelines" I would expect of a PGY-1, as I would MK2 3.4.c "Demonstrates sufficient knowledge to include relevant medical and neurological conditions in the differential diagnosis of psychiatric patients." Point being, that the milestones do not correlate with a specific year in training though advanced residents should be able to meet more level 4 milestones.

I havent heard it be an issue to fasttrack. is your program really that awful? even at terrible programs its common for lots of residents to fast-track in order to escape. most good programs don't "need" PGY-4 resident, but those that do will often advertise positions if they have too many residents fast-tracking.
Honestly, I don't understand why any resident with loans to repay would NOT want to fast track, regardless how "great" their program may be. Some say the 4th year is an added opportunity for leadership, electives, etc. But if one is steadfast in fasttracking, don't stay for the 4th year. What makes you think only dissatisfied residents want to fasttrack?
 
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