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Our program would deny you the ability to moonlight for poor ITE scores, which makes some sense - you should be spending the time studying. Otherwise, the only other penalty was having to come up with a study plan (which inevitably was "take more time to read").

That said... I doubt there's any rules against what your program is doing, other than just common sense.
 
Your program director sounds terribly misguided to tell you the truth. I'd go to your hospital's GME with something like that. You deserve to have your scores remain private and a policy such as this would insure it wouldn't be.
 
Mass Effect said:
Your program director sounds terribly misguided to tell you the truth. I'd go to your hospital's GME with something like that. You deserve to have your scores remain private and a policy such as this would insure it wouldn't be.
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Going to the GME is the nuclear option, and likely not a wise first move. While people may deserve to have their information remain private, it's unclear whether it would fall under formal protections like it would for information regulated by FERPA. Even so, the precise scores are not being divulged. At our program, people who fell below a certain threshold had to participate in remediation sessions.

As others mentioned, while the policy is likely "legal", practically it makes no sense. People who performe
poorly should be given more time to study...not less. I'd first have a meeting with then Program Director (with the whole residency), and if that is unsuccessful Id go to the Chair. Only after that would I comtemplate involving the GME.
 
Mass Effect said:
Your program director sounds terribly misguided to tell you the truth. I'd go to your hospital's GME with something like that. You deserve to have your scores remain private and a policy such as this would insure it wouldn't be.
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Whether scores are private or not is program and specialty dependent. I know of surgical programs that post every residents numerical score publicly for all the rest to see.
 
Raryn said:
Whether scores are private or not is program and specialty dependent. I know of surgical programs that post every residents numerical score publicly for all the rest to see.
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They likely get away with it because it hasn't been challenged. I realize there's this ambiguous line between residency and employment (student versus employee), but academic records are sealed for a reason and I would love for someone to challenge that surgical program's belief that it's ok to publicly humiliate its residents by posting their scores.
 
Mass Effect said:
They likely get away with it because it hasn't been challenged. I realize there's this ambiguous line between residency and employment (student versus employee), but academic records are sealed for a reason and I would love for someone to challenge that surgical program's belief that it's ok to publicly humiliate its residents by posting their scores.
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Challenging it would be a waste of time and money as it's not even a "gray area":

https://www2.ed.gov/policy/gen/guid/fpco/ferpa/library/richter.html

This is in response to your June 5, 1995, inquiry regarding the applicability of the Family Educational Rights and Privacy Act (FERPA) to the records of medical residents. As discussed further below, the records of medical residents are not protected by FERPA.

FERPA generally protects a student's privacy interests in education records. "Education records" are defined as:

those records, files, documents, and other materials which (i) contain information directly related to a student; and (ii) are maintained by an educational agency or institution, or by a person acting for such agency or institution.

20 U.S.C. § 1232g(a)(4). The term "student" is defined as "any individual who is or has been in attendance at an educational agency or institution and regarding whom the agency or institution maintains education records." 34 CFR § 99.3

A medical resident who works at a hospital is not a "student" as that term is defined in FERPA. The individual has received the Doctor of Medicine degree--the terminal degree for the profession--from a medical school and has completed his or her education as a "student." In most states, persons who receive a medical degree may not practice medicine without supervision until they have completed a period of residency and passed a State licensing examination. As medical residents, the individuals refine their skills and their work is evaluated for the purpose of determining whether they should be licensed to practice medicine. Evaluative records pertaining to their practical experience as doctors who have completed their education are not "education records" under FERPA. They are not directly related to students in attendance at educational agencies or institutions.
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Mass Effect said:
So why are disciplinary actions confidential? Are residents considered employees when it comes to this stuff?
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Yes. Per the federal government residents are employees and not students. This even went to the Supreme Court with regards to whether social security taxes need to be paid.
 
Raryn said:
Yes. Per the federal government residents are employees and not students. This even went to the Supreme Court with regards to whether social security taxes need to be paid.
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So if residents are treated like employees when it comes to disciplinary action, surely there are some safeguards against publishing their ITE scores?
 
Mass Effect said:
So if residents are treated like employees when it comes to disciplinary action, surely there are some safeguards against publishing their ITE scores?
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I'm not seeing any logical reason why there would be. Good practice and human decency, sure, but no specific laws.
 
Mass Effect said:
So if residents are treated like employees when it comes to disciplinary action, surely there are some safeguards against publishing their ITE scores?
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My employer posts my star rating and my quality measure reports for my colleagues to see. I don't see how it's legally any different.
 
I don't know, I guess it depends on how you view it. If there are consequences for low ITE scores (like in the OP's case), then one could argue that employee discipline should be private, just as it would be if someone got knocked for professionalism.
 
Mass Effect said:
I don't know, I guess it depends on how you view it. If there are consequences for low ITE scores (like in the OP's case), then one could argue that employee discipline should be private, just as it would be if someone got knocked for professionalism.
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Sure, you can argue it. But ultimately that's a contractual issue between the employer and employee. There are no legal safeguards. Your options are to work for the employer knowing they reserve the right to publish information, or find another employer who does have policies or contractual language specifically protecting it.

And getting knocked for professionalism wouldn't necessarily be "private". That's something that your program can disclose to other places (like future jobs) without your explicit permission. It also wouldn't be private if the consequences were "visible" (e.g. leave of absence, remediation, etc.).
 
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Merely said:
That’s a horrible policy that doesn’t even make any sense
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Agreed. More work wiil lead to less study time which will lead to poorer results in the future. No it's not against ACGME - a program can really do as they wish. As one of our chiefs once said, calls are not always fair lol.
 
Mass Effect said:
So if residents are treated like employees when it comes to disciplinary action, surely there are some safeguards against publishing their ITE scores?
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I would assume they are not posting your scores though right?
 
Piebaldi said:
I would assume they are not posting your scores though right?
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Even if they were -- as an employee, it does not seem to be protected information. For example, in sales roles, individual employee sales performance and quotas are published frequently. In production roles, production figures are routinely public. Customer service comments -- same thing.

Time to pull up your big girl/boy pants...

edit: I don't mean this scornfully, but rather as a "gotta accept that this is the way the world works."
 
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DokterMom said:
Even if they were -- as an employee, it does not seem to be protected information. For example, in sales roles, individual employee sales performance and quotas are published frequently. In production roles, production figures are routinely public. Customer service comments -- same thing.

Time to pull up your big girl/boy pants...
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That phrase is the ultimate excuse and tactic to defend anything one wants. While it may be legal to publicly post ITE scores, it doesn't make it right as we all know why it's done.
 
Mass Effect said:
That phrase is the ultimate excuse and tactic to defend anything one wants. While it may be legal to publicly post ITE scores, it doesn't make it right as we all know why it's done.
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To incentivize performance through threat of public shame? Yes, as mentioned elsewhere an age-old tactic used in all walks of life.

Don't get me wrong, I generally agree with what you're trying to say. But it's more about effective vs. ineffective than right vs. wrong. You may say that's a distinction without difference, but in my opinion trying to initiate change using the "this isn't right" argument doesn't work. It inevitably ends up sounding like whining, which gets you nowhere.
 
FaytlND said:
To incentivize performance through threat of public shame? Yes, as mentioned elsewhere an age-old tactic used in all walks of life.

Don't get me wrong, I generally agree with what you're trying to say. But it's more about effective vs. ineffective than right vs. wrong. You may say that's a distinction without difference, but in my opinion trying to initiate change using the "this isn't right" argument doesn't work. It inevitably ends up sounding like whining, which gets you nowhere.
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I disagree. Yes, it is public shaming, which actually does more harm than good and if the PDs in question don't realize that they have lost touch with where medical education is and is going. I dispute the claim that it's more about effective vs. ineffective. Perhaps that's how you see it. To me, it's bigger picture and the bigger picture is that public shaming/humiliation is not a good educational strategy and that's what we're talking about here -- education.

Also, "this isn't right" may sound like whining to some, but again, it's the truth as I see it and it has nothing to do with whining. One can dispute something that's occurring without "whining." It's so ingrained in us in medicine to just do what you're told and if you say "hey wait, that's not right," people call it whining or not putting on your big girl/boy pants when, in fact, sometimes the things being challenged actually aren't right. Just check out the PHP thread for further evidence of that. I'm also not trying to initiate change in this thread. In this thread, I'm just stating my opinion on things presented and my opinion is that it isn't right.
 
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Mass Effect said:
I disagree. Yes, it is public shaming, which actually does more harm than good and if the PDs in question don't realize that they have lost touch with where medical education is and is going. I dispute the claim that it's more about effective vs. ineffective. Perhaps that's how you see it. To me, it's bigger picture and the bigger picture is that public shaming/humiliation is not a good educational strategy and that's what we're talking about here -- education.

Also, "this isn't right" may sound like whining to some, but again, it's the truth as I see it and it has nothing to do with whining. One can dispute something that's occurring without "whining." It's so ingrained in us in medicine to just do what you're told and if you say "hey wait, that's not right," people call it whining or not putting on your big girl/boy pants when, in fact, sometimes the things being challenged actually aren't right. Just check out the PHP thread for further evidence of that. I'm also not trying to initiate change in this thread. In this thread, I'm just stating my opinion on things presented and my opinion is that it isn't right.
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Agree wholeheartedly with this
Public humiliation/shaming/whatever you want to call it is not a vehicle for helping people do better. Anyone who thinks that this is some form of effective education has either been brainwashed by the medical system of education we have been raised in or is a masochist/sadist.

In my cath lab, we have attendings who are jerks and think they are “teaching” by yelling and demeaning. The rest of them correct mistakes or refine technique through calm education (and before someone jumps on this, yes, even during emergencies like STEMI). I can tell you which one is more effective.

People can feel free to disagree, but this seems like common sense to me
 
So my interpretation of what @FaytlND was trying to say is that yes it is shaming and public humiliation and it’s not right but you’ll get further with your argument with these people if you say it’s not an effective educational strategy than you’ll get by crying foul ( even if the practice is truly abhorrent).
 
doctorette said:
Thank you for the replies. From what I gather this is not wrong or against ACGME policy, basically program can do whatever it wants. I suppose we will just have to power through.
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Honestly, it may seem unethical or unfair but it is just the tip of the iceberg.

Complication rates by physician are out there and insurance companies are tracking this information.
projects.propublica.org

Surgeon Scorecard

We calculated complication rates for surgeons performing one of eight elective procedures under Medicare, carefully adjusting for differences in patient health, age and hospital quality. Use this database to know more about a surgeon before your operation.
projects.propublica.org

Insurance companies are tracking C section rates/episiotomy rates for example and giving that information to patients so they can make decisions on who they want to see etc.
 
Mass Effect said:
That phrase is the ultimate excuse and tactic to defend anything one wants. While it may be legal to publicly post ITE scores, it doesn't make it right as we all know why it's done.
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A little bit of public shaming can go a long way. I pimp the occasional resident in the OR just to remind them that they need to read more instead of screwing around. Some residents are very self motivated but an equal number try to skate by with just the bare minimum. I don't yell or scream but the silence of them not knowing the answers to several relatively straightforward questions seems to get the point across.

And honestly, medical knowledge is generally not about being inherently smart or brilliant. You just have to sit down and grind through it.
 
anonperson said:
A little bit of public shaming can go a long way. I pimp the occasional resident in the OR just to remind them that they need to read more instead of screwing around. Some residents are very self motivated but an equal number try to skate by with just the bare minimum. I don't yell or scream but the silence of them not knowing the answers to several relatively straightforward questions seems to get the point across.

And honestly, medical knowledge is generally not about being inherently smart or brilliant. You just have to sit down and grind through it.
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Pimping is one thing (especially if the questions are straight forward) and public shaming is another. Public shaming does not work as an education strategy. It breeds resentment and a general dislike for learning. As an aside, none of the OB residents I know have time to screw around, but that's beside the point.
 
I don't know what the argument is about. Clearly, there are people who lose confidence and deteriorate with public shaming, but also there are those who need some and even thrive/ improve with it and would not realize the graveness of mistakes in our profession otherwise. A smart mentor is able to personalize the response.
 
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