University of Chicago "flunking" their anesthesia residents?

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MSPoor

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Hey guys, I'm a first-time poster, in the interview process for anesthesia residency.

Has anyone heard about U of C's practice of not graduating their residents? I heard that they've been keeping several of their residents for 6 months AFTER they were supposed to graduate residency. What I've heard is that it's not for gross incompetence, with many of their peers and even attendings being perplexed at why they were kept from graduating.

It seems like it basically screws these residents over, with at least a couple of them having to defer or cancel their fellowship plans??? I don't understand how a program could do this to their own trainees? Can anyone confirm this? If it's true I can't imagine ranking them.

Thanks in advance for any info.

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Hey guys, I'm a first-time poster, in the interview process for anesthesia residency.

Has anyone heard about U of C's practice of not graduating their residents? I heard that they've been keeping several of their residents for 6 months AFTER they were supposed to graduate residency. What I've heard is that it's not for gross incompetence, with many of their peers and even attendings being perplexed at why they were kept from graduating.

It seems like it basically screws these residents over, with at least a couple of them having to defer or cancel their fellowship plans??? I don't understand how a program could do this to their own trainees? Can anyone confirm this? If it's true I can't imagine ranking them.

Thanks in advance for any info.
1st time poster.

Northwestern 2.0
 
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Hey guys, I'm a first-time poster, in the interview process for anesthesia residency.

Has anyone heard about U of C's practice of not graduating their residents? I heard that they've been keeping several of their residents for 6 months AFTER they were supposed to graduate residency. What I've heard is that it's not for gross incompetence, with many of their peers and even attendings being perplexed at why they were kept from graduating.

It seems like it basically screws these residents over, with at least a couple of them having to defer or cancel their fellowship plans??? I don't understand how a program could do this to their own trainees? Can anyone confirm this? If it's true I can't imagine ranking them.

Thanks in advance for any info.
Other big anesthesia programs do this occasionally, too. In a 20+ residents/year program, there is always a chance for 1-2 underperformers.

Welcome to the surgical world, baby prey! We'll eat you for breakfast, then regurgitate you before eating somebody else for lunch.
 
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I am not from U of C, nor do I work as a program director or other residency administrator. However, it is my understanding that the ACGME follows this very strictly. Programs are not allowed to hold back their residents unless there is very strong consensus that they are severely deficient. To do otherwise would flag the program badly. It also reflects poorly on the reputation of the program itself to not graduate all of their class.

Bottom line: programs have A LOT of incentive to NOT hold back or fail residents for no reason. I imagine there is more to this story than what you're hearing.
 
Programs will create a beautiful paper trail to hold back any resident they intend to.

In my residency program, they threatened at least one resident every year, and every few years the threat became reality.
 
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During your career you will encounter physicians who should have been flunked but weren't. Board certified anesthesiologists who cannot do Aline's. It's astounding.
 
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That doesn't necessarily mean that they never knew how to do one, just that they haven't done one in ages.
 
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standing on the corner minding my business when.... all I am sayings is that there is always a reason.

I have done many interviews and am amazed by some of the simple questions people cant answer or the phone call/email from a previous employer who has "warnings" for us. Eventually it will catch up with the underperformers, should happen in residency though not when patients are relying on them to be competent,
 
I heard that they've been keeping several of their residents for 6 months AFTER they were supposed to graduate residency. What I've heard is that it's not for gross incompetence, with many of their peers and even attendings being perplexed at why they were kept from graduating.

Anesthesia's a funny field. A couple things -

Unlike most other specialties, our PEERS as residents generally have No Frickin' Clue how good you are or aren't. We're a specialty that practices alone 99% of the time. Maybe a co-resident will see you in action once a month if they're paired with you on call, or hear you speak once a month at a conference or journal club. But set aside the silly notion that your peers really know how good you are or aren't. Most of what they really know is hearsay and grapevine reputation.

Some people speak well and carry themselves with confidence, looking for all the world like they're on top of the world, then quietly put up a 10 on the ITE or repeatedly do something sloppy or inattentive or dangerous in the OR.

How often did/do you work individually with certain attendings? Once a month? Once every other month? Only when on specific subspecialty rotations? It's not surprising that some attendings will be "perplexed" by a resident getting held back, particularly if the nine whole days they worked with that resident in the last year happened to be good days and/or easy cases.

In this field especially, it's easy to look like a good resident from the outside just by showing up, working hard, mastering the monkey skills, being nice to people, and basically carrying out cookie-cutter anesthesia for your cases (most of the sick/complex ones have been preop'd by someone else anyway) ... while never opening a book and bombing every AKT and ITE. Just because a resident looks good, don't assume they aren't an inch away from flying off the rails.


Programs have a duty to not graduate people who aren't safe or up to standards. They are also powerfully motivated to graduate everyone on time. If someone gets held back, there's a reason. Odds are it isn't arbitrary or conspiratorial or inappropriate.
 
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It's not the AKT or ITE that holds back people. Unfortunately. Because at least those are objective stuff.

I think the anesthesia attending reviews are among the most subjective POS I have seen in my life. They spend 10 minutes with the resident for induction and 10 minutes or less for emergence, and then they have the nerve to judge him/her, plus gossip the heck out of it. This is one of the few specialties where the first impression is, many times, the last impression. Once you are labeled, you stay labeled. I have seen "superstars" who couldn't pass the ITE until their 3rd year (or not even) but, hey, they were great at brown-nosing. On the other hand, God forbid you can't get that stupid IV in the vascular patient on your own, especially with an academic who hasn't put one in for ages.

The truth is always somewhere in the middle. Where there is smoke, there is a fire, except that it might be way smaller than you were told.
 
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There is a push within GME to put the residents on flight paths and evaluate their progress formally at least q6 mo and closely track their progress. If they are off path they should receive formal evaluations with recommendations for remediation. If they fail to get back on track to graduate with the full complement of skills, they should be extended or let go.
We will likely see more extensions vs double secret probation as more programs adopt the recommendations.
 
If they fail to get back on track to graduate with the full complement of skills, they should be extended or let go.

What do you think the appropriate number of residents/year "off track" should be for a quality program? Everyone gates on so many things on the way in, so should good programs expect this to be a 1% problem or a 10% problem?
 
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What do you think the appropriate number of residents/year "off track" should be for a quality program? Everyone gates on so many things on the way in, so should good programs expect this to be a 1% problem or a 10% problem?

I think it depends a bit on the program, the residents, the time period being discussed and a few other factors.

If the program is top notch with stable accreditation that recruits the cream of the crop from the available student pool and then, suddenly begins to have a much higher number of residents that "wash out" of the program, that should send up some warning flags that something more serious might be going on. However, if a program has struggled and recruits mostly people who were in the fourth quartile of their graduating class and who may have struggled with standardized exams, it might be perfectly normal to expect that some of these low performers might need extra time or may not make it. Basically, a program's finished product (a graduating resident) is often determined by their initial ingredients (the graduating med student). If the students you recruit are low performers, it is hard to turn them into high performers, even in four years. By the time the program meets them, they are full grown adults with established habits and tendencies that difficult to change. So, the bottom line is, programs need to recruit high performing students in order to produce high performing graduates. Obviously, all PD's try to do that. The programs that are not well established or are located in undesirable places may struggle to do that, therefore, they may have more difficulty in getting their residents ready to practice independently.

Similarly, in the late 90's, all programs were struggling because very few med students chose anesthesiology as a career from 1996-1999. Having a pulse was the requirement for getting a very good residency spot. The rich (programs) did okay and the poor struggled to survive. Oral board pass rates dropped into the mid 50% range. I would venture a guess that there was a struggle to get many of those people through residency, as, ideally, the standards do not change just because the quality goes down.

All of that being said, if the number of residents who get held back or dismissed is >~10% or if it is a theme that 1-2 residents get held back every year, that could be a sign that you do not wish to be there for many different reasons. No one wants to work with a group of residents that struggle, whether it is of their own doing or the program's doing. Keep in mind, that a program that has 20 residents per year, one resident struggling suddenly jumps them into the 5% group. Think back to your med school class or your residency class and realize how many people in those groups were dysfunctional in some area, whether it was academics or professionalism. Five percent seems kind of low when you think about it that way. My own personal experience is that professionalism issues are the toughest issues to deal with and the most likely issue that leads to dismissal. Academic struggles can usually be overcome with increased studying and diligence. Sociopathic behavior is hard to change.
 
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Good posts Gern and pgg.

We had a few in my residency class that washed out. Although a couple were for personal reasons, one was clearly for performance issues and the other was for a horrible, argumentative, and over-confident attitude (which made him dangerous in not only my opinion but many other people's including the ones deciding to keep him in the program). One made it to PGY-3 before it happened.

Dude with the attitude "electively" left after being counseled and basically refusing to change. It was clear that he was more interested in being the alpha male than realizing his role on the team was supportive. And he did all kinds of risky ****. I think he's an oncologist nowadays. Very smart guy. That was never his problem.
 
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I agree that it is easy to fool attendings. We just had a education committee meeting and went through all the residents. There were a few residents that I thought were really lacking in knowledge and also in judgement. Obviously they have focused on their technical skills and got very positive remarks. When I commented that they lack judgement and basic knowledge people looked at me like I was crazy.
 
I agree that it is easy to fool attendings. We just had a education committee meeting and went through all the residents. There were a few residents that I thought were really lacking in knowledge and also in judgement. Obviously they have focused on their technical skills and got very positive remarks. When I commented that they lack judgement and basic knowledge people looked at me like I was crazy.
Just my experience as a resident. Co-residents whom I knew to be weak knowledge-wise (I had taken over patients from them in the OR/ICU/pain service etc.) were getting all these superlative reviews for essentially their brown-nosing skills, while people with extensive knowledge (as proven repeatedly by their test scores and patient care) but less social skills were looked down upon. Of course, only the first group got to call the attendings by their first name.
 
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My program was obsessed with numbers. Everyone knew how everyone did on their training exams and the director sent out the scores to the other faculty, "so that everyone could work with the people that were struggling."
I was lucky and did well on my exams and was one of the golden boys. The people that consistently got borderline scores were relentlessly beat down by their attendings for three long years.
 
I can't recall the exact details, but it's pretty well spelled out in ACGME requirements that if a resident is deemed deficient in one area that they have to go back through that rotation to demonstrate proficiency. I also recall hearing that depending on what it was or how bad it was that they had to require an extra 6 months training time (as in the 6 months wasn't optional to the program, but was required from ACGME).

Keep in mind I'm not in academics I just recall hearing something about this from my program director towards the end of my residency.
 
People don't realize how important the first six months of anesthesia residency are. Once you're labeled, you stay labeled. Then everything you do is seen through pink respectively black eyeglasses. That's why I say that the current system is highly deficient and subjective.
 
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I agree, attendings can be very judgmental for seemingly ridiculous things like how to tape the ETT. It doesn't help that you may go months without working with certain attendings. One tip that a previous chief gave me was to make preference cards for each attending. He told me he looked like a superstar because he always knew the little quirks and preferences for each attending (even stupid things like cloth vs plastic tape for ETT's). I didn't make cards, but I can think of a number of instances where they would have come in handy.

In terms of letting people go, programs have a strong motivation to graduate residents on time and at my shop you have to consistently fail both clinical evaluations and academic measures such as the ITE. It's usually quite difficult to fire a resident and to do it properly a paper trail has to be made to document that the program did everything possible to help the resident get back on track to graduate. Otherwise the PD/Chair/Staff are potentially vulnerable to individual civil suits and not protected by the institution's legal department.
 
I agree that it is easy to fool attendings. We just had a education committee meeting and went through all the residents. There were a few residents that I thought were really lacking in knowledge and also in judgement. Obviously they have focused on their technical skills and got very positive remarks. When I commented that they lack judgement and basic knowledge people looked at me like I was crazy.

^^^^ This!

Crucial!

Knowledge + Experience = Judgment. It takes time for some because everyone's learning curve is a little different. But I worry that we're focusing too much on technical skills and not enough on making sound clinical decisions. And part of that that includes knowing when to tone it down instead of bring the entire medical system into a case that doesn't need to be loaded for bear.
 
People don't realize how important the first six months of anesthesia residency are. Once you're labeled, you stay labeled. Then everything you do is seen through pink respectively black eyeglasses. That's why I say that the current system is highly deficient and subjective.


Very true. A high ITE score can help, but it's still an uphill battle. I've been sending a crash course anesthesia PDF out to the interns in hopes that they'd read it and have a leg up in July.
 
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People don't realize how important the first six months of anesthesia residency are. Once you're labeled, you stay labeled. Then everything you do is seen through pink respectively black eyeglasses. That's why I say that the current system is highly deficient and subjective.

This. Oh, man, this.
 
This. Oh, man, this.


Agree. Residents where I trained were practically labeled before we started. And the labels stuck. Maybe it was just my program, but It amazed me how caddy and ridiculous the department was as a whole, mostly because the attendings had so much time to shoot the **** and trash talk residents. Soooo much gossip. A department of teenage girls.
 
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I have the pleasure in the past 4 months to start receiving residents for Cardiac Anesthesia. Yesterday I filled out eval's and as I filled them out I realized a sub conscience standard. Does the resident have more or less knowledge than a newly graduated CRNA? Do they act well in a technical role (CRNA) or do they possess the needed ability to diagnose a problem, describe effectively the anesthetic implications, and defend they plan to a surgeon, ie are they able to be a physician consultant. I should be able, by the time a resident is a CA-3 , tto converse with them about a situation on a colleague/partner basis not on a King to peasant level.

If we want to produce anesthesiologist who are better than CRNAs then we must ensure that our graduates are indeed both technically competent and medically competent as a Physician. I stress to my residents be a physician first and not just a dial turner.

Looking back to my residency as well, I thought there was the appropriate emphasis on the technical aspects but the teaching of how to communicate to a surgeon effectively was learned during my CC fellowship.
 
FFP, you describe my situation to the T. You guys can see my posts from 2010. CA1 year, everything was fine. I bombed my AKT and ITE, because no one placed much emphasis and the old PD didn't care as long as we showed improvement. Problem is, he was on the way out and we didn't know it. Got a new PD who wanted to change the place. I am not a brown noser and am opinionated. New PD did not like me, and started stressing on the couple of negative evaluations and my poor ITE score from a year ago.
Word spread about my Unprofessionalism and that pissed me off and instead of keeping my head low I spoke out about it. Kept getting in trouble, placed on remediation. My next two ITE scores were I believe the best in the class, but not sure. However, I was the problem child already, the squeaky wheel. It seems everywhere I went I was getting in trouble. The Bitch PD ended up placing me on probation during my last year and attempted to extend extend my residency for 6 months. I fought it with the help of the union and won. In the meantime, developed serious anxiety, took time off and got on SSRI. It was a nightmare.

Of course being a woman with a strong personality in a professional world, can work against you. Wouldn't you know that in private practice I haven't had Professionalism issues, except for one write up from a nurse in two years. I left recently and the staff didn't want me to leave and I am the same person I was in residency, with a tiny bit of more sugar. What a different world private practice is.

What bull**** residency can be if some of the attendings don't like you.

Lesson learned and advice to the residents currently is , you gotta brown nose and "act like you are vying for an Oscar". That is the EXACT advice given to me by my "professionalism" professor/coach I had to see for six weeks in order to graduate.
 
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Advice to residents: Read, fly under radar, be interested, Taylor your anesthetic plan to what the attending likes, do well on ITE. Find an attending you like and feel comfortable with and pick their brain.

Brownnosing? Not necessary.
 
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I hated my training program with a passion. But based on the replies to this thread, it sounds like the experience is universal. Being a successful resident is not about practicing 'good' anesthesia, it is about practicing anesthesia the way your attending wants you to. God forbid you ever try thinking outside the box, you can expect a reaming and a bad evaluation for 'unprofessionalism' if you dare try to defend your decisions. That is one part of training that I do not miss AT ALL.
 
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I hated my training program with a passion. But based on the replies to this thread, it sounds like the experience is universal. Being a successful resident is not about practicing 'good' anesthesia, it is about practicing anesthesia the way your attending wants you to. God forbid you ever try thinking outside the box, you can expect a reaming and a bad evaluation for 'unprofessionalism' if you dare try to defend your decisions. That is one part of training that I do not miss AT ALL.
That wasn't the case where I trained at all. Though, as I said, they were very score oriented.
 
Mine either. I worked my rear-end off but I learned how to be a competent anesthesiologist. I worry (looking at some of the threads recently) that some of you guys expect to want to train at a country club. And then maybe just sign charts for the rest of your career while the mid-levels do all the heavy lifting.

Newsflash: That model is going to crash and burn. You either better know how to pass the gas yourself (and be really good at it) or you're going to have to find another specialty. Because when the CRNAs get full independent practice rights and they are left to fend for themselves, weak anesthesiologists aren't going to have a job anymore.
 
Mine either. I worked my rear-end off but I learned how to be a competent anesthesiologist. I worry (looking at some of the threads recently) that some of you guys expect to want to train at a country club. And then maybe just sign charts for the rest of your career while the mid-levels do all the heavy lifting.

Newsflash: That model is going to crash and burn. You either better know how to pass the gas yourself (and be really good at it) or you're going to have to find another specialty. Because when the CRNAs get full independent practice rights and they are left to fend for themselves, weak anesthesiologists aren't going to have a job anymore.

Malignancy has little to do with actual workload and everything to do with attitude, culture, and support. Many residents, myself included, did not mind long work hours as long as they were not being unfairly judged, yelled at, and otherwise berated. It isn't about being lazy, it's about not being treated like complete trash.
 
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Advice to residents: Read, fly under radar, be interested, Taylor your anesthetic plan to what the attending likes, do well on ITE. Find an attending you like and feel comfortable with and pick their brain.

Brownnosing? Not necessary.
I agree. You need to be a team player who is willing to pull their weight, not be a whiner, and be generally nice to people. Nothing more is needed. People recognize a brown noser and it is not an attractive quality. It may keep people from being mad at you, but it will annoy people too. Just treat people how you would want to be treated, do your work, provide vigilant patient care, complain only when it is about something that really matters, study hard, and do well on the ITE's. Repeat x 4 years and you are done with top notch evals and ready to pass the boards.

Pretty common sense stuff.
 
My experiences mirror that of FFP's...Was an off cycle resident at a large program who fell behind and got labeled. The same mistakes that other residents would get away with, would become a huge deal when it happened to me. Ultimately ended up leaving a prominent program in the south. Please PM if you have questions.
 
We have to question whether it's a systemic problem with medical education? There is a problem if we have to brown nose, do all the scut work, not have time to study. Internship and residencies were and are living nightmare. All this has to be audited by Medicare. If the programs are getting funds to teach residents, but they do not provide resources to the residents, but instead are diverting funds, whistle blower protection laws need to apply.

The residents are here to learn. If they do hard work and do what they are told to do, then the system is at fault for failing the students. How can ca1 intern know about medical judgement when lots of surgeons and gynecologists don't?
Is it because the surgeons bring in the money and administration is in bed with them?
 
The percentage of people who are unfairly labelled and unjustly punished to those who think they are unfairly labelled and unjustly punished is likely very low. Not to say it isnt happening, but you need to take a hard and honest look at yourself in this situation, and drop the defensiveness.

There are some really bad residents and doctors out there. If UofC has that type of resident (and we all know them) and they are holding them back rather than doing the easy thing and passing them along, I agree with this. Much better to add a year to your training to remediate than to drop a dangerous guy on the world who will inadvertently kill someone or someones.

Be the best, never make the same mistake twice. As has been discussed elsewhere, you are owed nothing for being where you are, but put your head down and work hard. Rewards will come later, residency is a time to dedicate as fully as possible to learning this craft and making yourself as well educated and polished as possible. If you are up to date on all the latest TV shows, or hottest night spots, AND find yourself labelled poorly, you probably need to look at how you are spending your time. If you are living an enjoyable life outside of work and doing well on tests and clinically, more power to you.
 
FFP, you describe my situation to the T. You guys can see my posts from 2010. CA1 year, everything was fine. I bombed my AKT and ITE, because no one placed much emphasis and the old PD didn't care as long as we showed improvement. Problem is, he was on the way out and we didn't know it. Got a new PD who wanted to change the place. I am not a brown noser and am opinionated. New PD did not like me, and started stressing on the couple of negative evaluations and my poor ITE score from a year ago.
Word spread about my Unprofessionalism and that pissed me off and instead of keeping my head low I spoke out about it. Kept getting in trouble, placed on remediation. My next two ITE scores were I believe the best in the class, but not sure. However, I was the problem child already, the squeaky wheel. It seems everywhere I went I was getting in trouble. The Bitch PD ended up placing me on probation during my last year and attempted to extend extend my residency for 6 months. I fought it with the help of the union and won. In the meantime, developed serious anxiety, took time off and got on SSRI. It was a nightmare.

Of course being a woman with a strong personality in a professional world, can work against you. Wouldn't you know that in private practice I haven't had Professionalism issues, except for one write up from a nurse in two years. I left recently and the staff didn't want me to leave and I am the same person I was in residency, with a tiny bit of more sugar. What a different world private practice is.

What bull**** residency can be if some of the attendings don't like you.

Lesson learned and advice to the residents currently is , you gotta brown nose and "act like you are vying for an Oscar". That is the EXACT advice given to me by my "professionalism" professor/coach I had to see for six weeks in order to graduate.

I disagree with "having" to be a brown nose. I was far from that and did fine. Just gotta learn to let stuff roll off.

When stuff didn't just roll off, I made sure I was responding to someone and not starting something.
 
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