Has anyone ever seen/witnessed a terrible, like really bad and untalented first year resident who at the end of their residency, became very very good?
Bad, according to whose judgment? I thought most people labeled as "bad residents" generally weren't actually bad.
I was faculty at a small residency program for 8 years.
I can only think of one resident that I thought had significant "attitude" or work ethic problems, but there were a lot more that got that label. Mostly undeservedly, I think. I usually felt it was more of an attending personality problem than a resident problem, because they seemed to have fine habits when I worked with them.
It's real easy to catch the "bad resident" label as a new CA1. A couple bad days in the OR, a couple bad pimp questions during group academics, a mediocre or bad AKT-0 -1 or -6 score (not sure if those tests still exist). And you're the resident on the radar, as attendings talk amongst themselves about who's good and who's not. Most of that gossip is crap.
That said, it's also easy, as a CA1, to fall behind your CA1 peers and not know it for months because you never work directly with your peers, never take call with them, and usually don't get great feedback from the revolving door of attendings you work with. Self assessment as a CA1 is really hard, and attending assessment of CA1s is usually spotty and inconsistent and just plain poor.
Of the handful of genuine problem residents we had, the two recurrent issues were
1) Academics. Really low ITE scores (as in low single digit percentile score, not a merely disappointing 18th %ile result) just don't seem to get better and their board pass rates are low. These residents are easy to identify early because you have an objective test score, and the program can try to help them. I was assigned as a mentor to two over the years and one improved and passed his boards. One didn't and ultimately left the program. I'm not sure I helped either in a meaningful way. Some of it might be work ethic and study time, but some people just have trouble making time-pressured decisions, whether on tests or in the OR. Those people probably belong in another specialty.
2) OR awareness and ability to manage cases and avoid complications. I don't mean monkey skills like tubes and lines and blocks. Everyone gets that stuff eventually. I mean the hard to define ability to multi-task and see the case well enough to pre-empt small problems before they become big problems. These residents are hard to identify early, hard to remediate, and hard to fire because it's so hard to quantify and document what they're missing. They're usually just fine academically, have good work habits, are personable and professional, but just don't GET IT when it comes to anesthesia. They belong in other specialties where they can reflect on a problem and take time to make a decision, when patient neurons aren't actively becoming hypoxic as minutes tick by.
It's important to remember that attending faculty at residency programs are rarely great teachers. They have NO formal training in education, teaching methods, curriculum design, evaluation of learners, how to give actionable feedback, how to remediate struggling learners or even how to identify them in the first place.
So - I think the "bad resident" label is almost always bull****. I've seen a whole lot of "bad residents" graduate and become fine anesthesiologists.
