Probation or resignation in lieu of probation

[DrRocksoDO]

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Hello SDN,

Been a long time since I was here.

I am another unfortunate soul who has arrived at the receiving end of probation for difficulties in communication with a few select female attendings and my perceived reception to feedback being lacking from both male and female attendings. This continued on for about 6 months of Performance Improvement Plans during my 2nd year, involving my program requiring me to keep a feedback log, which was persistently poorly kept because when I would ask for formalized feedback the attending would often state they had no feedback for me, but when they did have some feedback I would do my best to be a good listener, and I would ask afterward "was there anything about my interactions that indicated I was not receptive to your feedback?" And I often got no as an answer. I thought I was doing well, but sure enough at every meeting the general vibe was that I was not improving as expected in this domain. I frequently stated during this time that I don't understand where these receptiveness to feedback events were occuring and asked for specific instances so that I could deep-dive into an improvement plan. For about 1 to 2 of the bad interactions with the female attendings I did successfully learn a lot. These often were due to them perceiving that I was arrogant, dismissive, and not taking them seriously (really though, in my head I was ****ting bricks).

But my program always turned it back on me stating that was on me to identify these instances. Unfortunately, a particularly bad rotation on Labor and Delivery (due to really poor communication breakdown with the midwives and their expectations on the rotation) led to a failed rotation, which resulted in automatic elevation to our competency committee who recommended probation. I decided at that time it would be a good idea to get neuropsych testing, having long thought that I probably had ADHD which may cause attention issues during feedback - the real result: ADHD inattentive type and Level 1 Autism without intellectual disability. Wow, that was enlightening to learn. Specifically in my testing it was stated that I would most benefit from clearly documented feedback while receiving feedback which identifies specific behaviors with realistic outcome dependent goals rather than generalized vibes of being resistant to feedback. The GME committee then approved the vote on probation, without knowing my diagnosis. My program now knows, and I assume feels like garbage because it's likely they probably wouldn't have pushed the issue so hard if they had known about my diagnosis, but have the full intention of pursuing probation regardless at this point (I think to save face, personally). They have given me the option before signing the probation document to resign, in which I'd have absolutely nothing on my record other than "resignation in lieu of probation", however once we start probation this is something I will have to report moving forward. I'm almost certain that once started I will not be terminated for probation, because at this point I'm already getting Psych help, and it would probably border on discrimination given my new diagnosis.

Part of me can't help but feel like all this is just ethically wrong. I was obviously conveying things non-verbally that I was completely unaware of, maybe doing so my whole life. I'm really leaning heavily towards taking the "resigned in lieu of probation" route and just trying to take a year to learn how to act like a normal human with my Psych treatment team.

What do you think?

 

[GoSpursGo]

Sorry that you have clearly had a lot of trouble during residency. You didn't say, but are you in OB/GYN? FM? EM?

While your diagnosis is real, it does not change performance, and if your performance was felt to be poor enough that it resulted in a failed rotation then having a diagnosis doesn't change that. You're allowed to request reasonable accommodations, but it doesn't retroactively excuse the performance that led to your failed rotation, and they can't be at fault for not providing reasonable accommodations that you didn't request. So the bottom line is that what's done is done--you failed your rotation and you are going to be on probation if you don't resign.

"Resignation in lieu of probation" is no better than being terminated following probation, and may actually be worse, because it means that you did not want to try and correct the problems with your performance. I'm just going to be honest--you need to accept probation, request whatever reasonable accommodations you think would enable you to successfully remediate your failed rotation, and then return and be the best version of yourself. Show up early, request feedback proactively, and do whatever it is they tell you to do. Training is a short period of time, but if you are dismissed from your program you run a real risk of never completing your training.

 

[Apollyon]

This sounds like one of those insidious Performance Improvement Plans that superficially look attainable, but, in reality, can't actually be completed. Small minds are very effective at menial plans.

 

[DrRocksoDO]

This sounds like one of those insidious Performance Improvement Plans that superficially look attainable, but, in reality, can't actually be completed. Small minds are very effective at menial plans.

That is exactly what it was and I even told my advisor at the time they first started it, that this would undoubtedly end up in probation because there is no concrete, objective measurement of it being met.

 

[NotAProgDirector]

I'm going to restate / repeat much of what @GoSpursGo said above, using your text as a launch point

The GME committee then approved the vote on probation, without knowing my diagnosis. My program now knows, and I assume feels like garbage because it's likely they probably wouldn't have pushed the issue so hard if they had known about my diagnosis, but have the full intention of pursuing probation regardless at this point (I think to save face, personally).

This is completely incorrect, and thinking about it this way is certain to get you into more trouble. You clearly have a communication problem, and now you have a diagnosis. Mild autism is characterized by missing non-verbal / emotional cues of others. When you would ask people for feedback afterwards, they had likely been trying to give you indirect feedback all along which you just miss. By the time you're asking, they are so frustrated and the figure you just don't care, so they just say nothing.

In any case, your prior poor performance stands. A diagnosis now might explain the issue, but it's not retroactive excuse for your prior poor performance. In fact, it's very difficult to improve with these diagnoses -- it certainly can be done but it's difficult, long work. It's unfortunate it took this long to get here, but it is what it is. This is NOT about saving face. This is about your poor performance.

I'm almost certain that once started I will not be terminated for probation, because at this point I'm already getting Psych help, and it would probably border on discrimination given my new diagnosis.

Another very bad thought. It's not discrimination at all. Now that you have a diagnosis, they need to make reasonable accommodations for you. That does NOT include excusing your prior poor performance, nor giving you extended time to improve. They can definitely say you have 3 months to resolve this issue, and if not by then they can fire you. You'll need to decide what reasonable accommodations you might want. If you need medications to get this under control, then you'll seriously want to consider an LOA for several months. Altering your schedule might or might not be reasonable. What you definitely should do is tell people, in advance, what your problem is and that you want them to interrupt you when they see problems -- because they WILL see problems. And you need to make sure you don't discount ANYTHING someone tells you, no matter how minor it seems to you.

Part of me can't help but feel like all this is just ethically wrong. I was obviously conveying things non-verbally that I was completely unaware of, maybe doing so my whole life. I'm really leaning heavily towards taking the "resigned in lieu of probation" route and just trying to take a year to learn how to act like a normal human with my Psych treatment team.

What do you think?

No, this is not ethically wrong - another bad thought that will only cause you problems. The better word IMHO is "unfortunate". It would have been much better for you to know this earlier. But it's not illegal nor unethical for your employer to hold you to minimum standards, even if the reason you're not meeting those standards was an unknown problem. And there's no guarantee that you'll improve enough in a reasonable time frame.

 

[HemeOncHopeful19]

I would suggest you strongly consider transitioning to a less clinically interactive field such as Pathology

 

[DrRocksoDO]

I won't make excuses, thank you everyone for your advice.

 

[dozitgetchahi]

One thing I’m going to say is that there are quite a few physicians out there who are quite obviously “on the autism spectrum” - some formally diagnosed, most not. And yet the vast majority of these docs get through training ok and function more or less ok as physicians.

All of that said, I have no idea how you’re being treated in this situation because I’m not there to see what is going on. It’s possible that you have a big communication deficit - but it’s also possible that you’re being railroaded by a program that has singled you out somewhat (seen it happen in one of my own programs). That said, even the most awkward and poorly communicative residents I saw in training didn’t fail rotations.

You have to figure out what is expected of you and do it. Most of the seemingly autistic doctors I’ve encountered may be somewhat awkward communicators - but they are generally very effective at doing the actual job of “physician”. Failing entire rotations sounds less like a communication problem, and more like an issue with actually following through on tasks etc. And that is a big deal. Communication issues may be ameliorated somewhat by switching to a less directly clinical specialty like pathology, radiology etc - but issues with carrying out tasks won’t.

I agree that “resignation in lieu of probation” would look bad on a record, and maybe even worse than having been on probation. If you want to be a doctor, your best bet is in figuring out how to get through this program. If things have gone as badly as it sounds, then I don’t know how supportive they would be of switching specialties either.

 

[DrRocksoDO]

One thing I’m going to say is that there are quite a few physicians out there who are quite obviously “on the autism spectrum” - some formally diagnosed, most not. And yet the vast majority of these docs get through training ok and function more or less ok as physicians.

All of that said, I have no idea how you’re being treated in this situation because I’m not there to see what is going on. It’s possible that you have a big communication deficit - but it’s also possible that you’re being railroaded by a program that has singled you out somewhat (seen it happen in one of my own programs). That said, even the most awkward and poorly communicative residents I saw in training didn’t fail rotations.

You have to figure out what is expected of you and do it. Most of the seemingly autistic doctors I’ve encountered may be somewhat awkward communicators - but they are generally very effective at doing the actual job of “physician”. Failing entire rotations sounds less like a communication problem, and more like an issue with actually following through on tasks etc. And that is a big deal. Communication issues may be ameliorated somewhat by switching to a less directly clinical specialty like pathology, radiology etc - but issues with carrying out tasks won’t.

I agree that “resignation in lieu of probation” would look bad on a record, and maybe even worse than having been on probation. If you want to be a doctor, your best bet is in figuring out how to get through this program. If things have gone as badly as it sounds, then I don’t know how supportive they would be of switching specialties either.

I think one thing that is extremely difficult to convey online and in the forum setting is that my communication with 95% of people is not lacking. I can't emphasize enough that if I went out for a beer with anyone in this thread you would not walk away with "wow that guy is autistic". Most people I tell about my diagnosis either respond in 1 of 2 ways:

Disbelief, that I actually don't have autism or that if I do that I must mask well because they didn't see that one coming

And I think that I do mask well from a social standpoint. But when people really get into my mental space (formal feedback, giving me instructions, telling me to follow up on something) the communication goes from a social perspective to an interpretive/mechanistic perspective and that's where the "differences in interpretation" become more obvious. Again, it's hard to explain but I actually find socialization easy, the neurodivergence (sorry, I do hate that word) comes in communication of expectations and instructions. This is by and large an issue with supervising providers, and to some degree there is a mismatch in interpretation of my motives. The frame before my diagnosis was that I was a blowhard that didn't listen to their supervisors, the frame after is that I might actually have some difficulty comprehending their instructions as stated. The unexpectedness of the diagnosis does have some relevance here.

 

[dozitgetchahi]

I think one thing that is extremely difficult to convey online and in the forum setting is that my communication with 95% of people is not lacking. I can't emphasize enough that if I went out for a beer with anyone in this thread you would not walk away with "wow that guy is autistic". Most people I tell about my diagnosis either respond in 1 of 2 ways:

Disbelief, that I actually don't have autism or that if I do that I must mask well because they didn't see that one coming

And I think that I do mask well from a social standpoint. But when people really get into my mental space (formal feedback, giving me instructions, telling me to follow up on something) the communication goes from a social perspective to an interpretive/mechanistic perspective and that's where the "differences in interpretation" become more obvious. Again, it's hard to explain but I actually find socialization easy, the neurodivergence (sorry, I do hate that word) comes in communication of expectations and instructions. This is by and large an issue with supervising providers, and to some degree there is a mismatch in interpretation of my motives. The frame before my diagnosis was that I was a blowhard that didn't listen to their supervisors, the frame after is that I might actually have some difficulty comprehending their instructions as stated. The unexpectedness of the diagnosis does have some relevance here.

How did medical school go?

How was the rest of residency going? Was this just an isolated issue with a few attendings? Sounds like you may have been doing ok otherwise?