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Created a throwaway account just because my other one could easily identify me. Also going to be vague on details for the same reason. Anyway, I need some advice on what to do. My PD and I have not had the world's best relationship for quite some time--probably since toward the end of my PGY-1 year and I'm now a PGY-3. I just found out that sometime around a year ago, another faculty told some other residents (who are now done and out in the real world) about what she had been telling them about me. I guess she said she wanted to fire me, but was afraid of getting sued. Instead, she told them that I was close to quitting (true, mostly because I was/am sick of being targeted by her), so they needed to keep riding me so that I would quit. Not much has changed in that time, I get told all the time that I'm a terrible person and terrible doctor even though my testing scores are higher than all of my classmates and I've done way more in the way of academic endeavors. This program has a history of choosing one person to pick on, and two of the last three of those people have quit. How do I deal with this news? I feel completely blindsided and don't even know what to say. For someone who is supposed to be my adviser and my advocate, this behavior is unacceptable.
Thanks for your thoughts.
You could start a complaint with the ACGME before they make up something on you to get you kicked out.
... I get told all the time that I'm a terrible person and terrible doctor even though my testing scores are higher than all of my classmates and I've done way more in the way of academic endeavors...
Not that this would ever justify singling you out to try and make you quit, but I note that the metrics you chose to emphasize are actually not those most of us would point to in terms of being a "good doctor". In truth if you are primarilly achieving on tests and academic pursuits rather than clinically, you could still be falling short on the things that actually matter to your program/PD.
I only mention this because I know someone who was not renewed for (good) cause, and throughout the process he couldn't seem to grasp why the PD kept focusing on his conduct on the wards rather than his above average inservice scores and research. So I wouldn't try and defend with that.
You could start a complaint with the ACGME before they make up something on you to get you kicked out.
It really does depend on your situation and how comfortable you are knowing that the battle lines have been drawn. You will not win the resident of the year award but at least you are somewhat protected during your residency.
Not that this would ever justify singling you out to try and make you quit, but I note that the metrics you chose to emphasize are actually not those most of us would point to in terms of being a "good doctor". In truth if you are primarilly achieving on tests and academic pursuits rather than clinically, you could still be falling short on the things that actually matter to your program/PD.
I only mention this because I know someone who was not renewed for (good) cause, and throughout the process he couldn't seem to grasp why the PD kept focusing on his conduct on the wards rather than his above average inservice scores and research. So I wouldn't try and defend with that.
Yes and this is precisely why people need the most objective evaluations and feedback that they can get. Personally, I think PDs need to be accountable for constructing the most objective systems of evaluation and prognostic indicators as possible. It would be beneficial to the whole program as well as the residents. And it would teach other residents how they should strive to fairly and effectively evaluate those under them; for often they do not, and it's easier to just respond capriciously.
Well, a lot of being a "good resident" involves things that cannot be usefully distilled into objective measures (teamwork, bedside manner, dependability, diligence). This isn't a kind of training where you can say all I expect from you is to check the X, Y and Z boxes and score over W on your tests. You really truly are hiring residents with the expectation that they can make smart decisions in your absence, work well in both supervised and nonsupervised settings, implement plans, not cut corners, Etc.
Every year I was a resident, programs rolled out more detailed semiannual review forms relating to the ACGME milestones, with more and more boxes for supervisors to check, and frankly those additional criteria did nothing to help you as resident to understand where you weren't cutting the mustard, they just gave programs more opportunities to suggest a resident was lagging behind on some metric. Not buying that this works more as a shield than a sword, so IMHO you only think you want this, until you see it in action.
I cannot comment on your cardio thoracic evaluation system specifically, but have seen many iterations of what you describe in terms of the "detail 4 explicit examples" form of evaluation and I assure you that that same system is even better at documenting subjective failures than objective achievement. People only want this kind of feedback until they are on the negative end.Understood. But these can be written out in specifics. Example. Detail 4 explicit examples of how resident demonstrative effective teamwork. This can be done in the positive and the negative. This means you are requiring someone take the time to support how or how not someone met the expected behavioral/teamwork requirements. It can't be a checkbox, but that is what everyone wants out of ease. Expounded SMART criteria or the like can be used.
The reason why employers and the like do not like to have more objective means and measures is that they want the capriciousness; that is to say, they want the ability to play with pretext in order to oust someone that may not like for whatever reason--legitimate or not. If the standard becomes more objective, if gives those that hold the power less wiggle room from a legal standpoint. No one wants to address the realities on this. Sure there are people that don't cut the mustard for a number of reasons. But let's use fair play, consistently applied,objectively measurable systems, acting in good faith, and due diligence with teaching and evaluation. They go hand and hand. How else will you truly know if there is soundness or not room for improvement in a particular program of learning if you think that evaluation may not also be affected by the system of teaching. It can't be simply b/c 5/6 of this particular group are doing fine, but this odd ball is not. That indeed may be the case; but with the capriciousness of people and politics, that often enough is NOT necessarily the case. I am all for being likable; but this will vary, and in a world that claims openness to diversity, that should also include personality types and such. It can't be about polarizations and targeting individuals just because. Idiotic. And it happens far to often in the work world.
Also, by the way, to your last part Law, indeed I have seen it in action at a world renowned cardiothoracic recovery unit in which I worked. The system of evaluation and prognostic indicators were the best I have seen ANYWHERE hand down. And people influenced each other by following them and by example, such that the level of work and outcomes throughout were beyond excellent. Yes. It can and does work if it's smart and applied consistently and well. Of course, it takes work and consistency and people have to be trained in yet one more thing. "Oh no!" God forbid.
I cannot comment on your cardio thoracic evaluation system specifically, but have seen many iterations of what you describe in terms of the "detail 4 explicit examples" form of evaluation and I assure you that that same system is even better at documenting subjective failures than objective achievement. People only want this kind of feedback until they are on the negative end.
The problem is the people doing the evaluation have already made subjective decisions about the trainee, so these objective measures aren't being done to "help" the trainee improve so much as document failures.Please help me understand why objective systems of evaluation are not more beneficial to the person under evaluation? How can they not help him/her hone in on what is really a true issue in terms of performance--social as well as otherwise? How is depending on the easier/lazier, capricious approach better? The only people non-objective systems help are those that desire the freedom to BE CAPRICIOUS. They do not want to validate their objections, b/c they know they are BS. This of course is not true in all cases/situations, but often enough, it certain is so. Just b/c the world is unfair in general doesn't mean we should embrace the unfairness b/c "that's just the way it is." If you can know to do better, you definitely should.
Well, a lot of being a "good resident" involves things that cannot be usefully distilled into objective measures (teamwork, bedside manner, dependability, diligence). This isn't a kind of training where you can say all I expect from you is to check the X, Y and Z boxes and score over W on your tests. You really truly are hiring residents with the expectation that they can make smart decisions in your absence, work well in both supervised and nonsupervised settings, implement plans, not cut corners, Etc.
Every year I was a resident, programs rolled out more detailed semiannual review forms relating to the ACGME milestones, with more and more boxes for supervisors to check, and frankly those additional criteria did nothing to help you as resident to understand where you weren't cutting the mustard, they just gave programs more opportunities to suggest a resident was lagging behind on some metric. Not buying that this works more as a shield than a sword, so IMHO you only think you want this, until you see it in action.
The problem is the people doing the evaluation have already made subjective decisions about the trainee, so these objective measures aren't being done to "help" the trainee improve so much as document failures.
Totally agreed.
The milestones are largely nebulous and based on subjectivity anyway. There's nothing actually 'objective' about them.
It's as if you asked a group of liberals and a group of conservatives to 'assess the milestones' of Obama's development as a president by checking a bunch of boxes on a form. You think those assessments are going to be similar between the two groups?
I'm not sure it would. A resident's only real defense against the subjective and random nature of residency evaluations is that there are a LOT of evaluators, most of whom don't talk to each other very much. You can bury a hater under dozens of good reviews. Doing something like filing a complaint with the ACGME can make a lot of people who otherwise might have written generic or good evaluations see you as a problem child, and once you start getting bad feedback from all of them the PD has 'objective' data to use against you.If anything it gets people to be on their best behavior.
I'm not sure it would. A resident's only real defense against the subjective and random nature of residency evaluations is that there are a LOT of evaluators, most of whom don't talk to each other very much. You can bury a hater under dozens of good reviews. Doing something like filing a complaint with the ACGME can make a lot of people who otherwise might have written generic or good evaluations see you as a problem child, and once you start getting bad feedback from all of them the PD has 'objective' data to use against you.
If you think you have something really egregious and concrete for the ACGME to act on it might still be worth it, but I would only light the fuse if you're pretty sure you can sink the person who is harassing you. I don't think you want this particular shot going across the bow.
Scrutinize all your evaluations to this point (every single one). If there isn't paper to get your fired, you really can't be fired. You can, however, just not be renewed year by year. Take a hard look at the policies from your overseeing GME office for resident termination/non-renewal. If you have 1-2 years left, you should try to finish. Otherwise, you may consider transferring before the hammer drops but that is a risky proposition.
Test scores and academic accomplishments are meaningless in this process.
Do you still want to practice this residency?
You have no basis for an ACGME complaint. You might have a basis for an equal opportunity complaint if the PD singled you out. Hold onto those cards (take detailed notes on who told you what and when).
Scrutinize all your evaluations to this point (every single one). If there isn't paper to get your fired, you really can't be fired. You can, however, just not be renewed year by year. Take a hard look at the policies from your overseeing GME office for resident termination/non-renewal.
I'm not sure it would. A resident's only real defense against the subjective and random nature of residency evaluations is that there are a LOT of evaluators, most of whom don't talk to each other very much. You can bury a hater under dozens of good reviews. Doing something like filing a complaint with the ACGME can make a lot of people who otherwise might have written generic or good evaluations see you as a problem child, and once you start getting bad feedback from all of them the PD has 'objective' data to use against you.
If you think you have something really egregious and concrete for the ACGME to act on it might still be worth it, but I would only light the fuse if you're pretty sure you can sink the person who is harassing you. I don't think you want this particular shot going across the bow.
A PD can make your life a living hell and can trump all the other evaluations. All I can say is that by Having the ACGME and GME in the department changes the culture if not to "waste" the PD's time. I've seen it where it allowed the resident to never have to be in the same room as the PD for the rest of their residency training.
I think if the OP feels he/she rather go through that, although extreme, it may be worth it. I've seen witch hunts and they can turn out ugly. I believe it's better to act now then later... The best defense sometimes is a real good offense. You have more power than you realize if what you claim can be supported as stated by the previous poster above.
Yes I agree. But I also am not saying OP is necessarily at this point yet. It really depends upon all the specifics. Clearly we are NOT privy to all the specifics.
No doubt, I agree and not recommending this for anyone to be a knee-jerk reaction. It's up to the individual to make the right decision and to understand the ramifications of his/her actions. In my experience, the resident had no choice and it worked out to protect not only him but other residents who came down the line who felt the same way.
A PD can make your life a living hell and can trump all the other evaluations. All I can say is that by Having the ACGME and GME in the department changes the culture if not to "waste" the PD's time. I've seen it where it allowed the resident to never have to be in the same room as the PD for the rest of their residency training.
I think if the OP feels he/she rather go through that, although extreme, it may be worth it. I've seen witch hunts and they can turn out ugly. I believe it's better to act now then later... The best defense sometimes is a real good offense. You have more power than you realize if what you claim can be supported as stated by the previous poster above.
Concerns cannot be used to adjudicate individual disputes between individual persons and residency/fellowship programs or sponsoring institutions regarding matters of admission, appointment, contract, credit, discrimination, promotion, or dismissal of faculty members, residents, or fellows.
That's not what was said. I get the feeling from your posts that you're misrepresenting and exaggerating things, and this is just one clear example where I can see how you took something someone said and turned it into something else.So if a dominant group of nurses get together and complain that said resident treats them in a condescending manner, even if it is not at all true, the resident gets fired?
So if a dominant group of nurses get together and complain that said resident treats them in a condescending manner, even if it is not at all true, the resident gets fired? Maybe it is possible that there is some serious level of unawareness re: how people and indeed nurses can group-act and rally against someone and get them ousted. I am a nurse, so I won't say they shouldn't be heard necessarily. But I have had to comment and get on nurses that were only to happy to slam the intern and make him or her feel like crap. Of course all nurses are not like that. But there is some weird % of nurse antics within certain places that are just, well, toxic. It happens more than people know. I have also seen a number of good to great nurses get weeded out b/c of this kind of cultural illness. That is not the kind of culture anyone should be OK with having. No one is asking for a perfect world. But when there is the potential to objectively do better and impart the discipline and commitment to a more objective system and it's application, that is what needs to happen.
Thank you for the quote from ACGME. Regardless of what they do, if it is called for, and I have no idea if that is so in this case, they should be made aware. Why? B/c it reflects something that can ripple throughout the system.
Med Schools may be swimming in MS applicants today, but looking at so many factors, and the major time, energy, and huge money investment to become a part of the medical profession, applicants will only opt to do something else, especially if capricious measures are a big enough part of the MS or GME systems. Given all the overwhelming burdens of the process, it may indeed just be too much for more and more people. There are a number of MS grads that have openly spoken here and elsewhere that they would not repeat the process if they had it to do all over again. Some of that may have been due to a lack of awareness about what medicine is about--they didn't get nearly enough upfront, clinical exposure. But the other part may be people have felt a bit too much abuse in a very long, demanding system that may really need to be improved. It would be foolish for people to keep their heads in the sand about this kind of thing. Also, credentials alone do not make good leaders, and that's what a PD is, a leader; is it not?
Again this particular situation is very unclear, and no one can really give a completely intelligent perspective on it. Still, I have seen this kind of abuse occur. Poor resident performance should not be tolerated, but neither should poor systems of evaluation and capricious nonsense be allowed to destroy someone's career--especially after so much time, energy, money and such have already been invested. I have to be honest in saying that I have seen downright unethical handling of people b/c of inside politics and such in HC.
Again, if this woman in this case is truly innocent, she definitely should not run away with her tail between her legs and heed the words of "Tough luck. Life is not fair." It takes courage to seek justice.
That's not what was said. I get the feeling from your posts that you're misrepresenting and exaggerating things, and this is just one clear example where I can see how you took something someone said and turned it into something else.
Not sure what you are trying to communicate here. That's an honest statement. Indeed, we have no knowledge that this was at all the case with the individual in the OP. At least I haven't read that. But if you are suggesting that behavior cannot have a more objective system of evaluation, I would respectfully disagree with you. Again, it's not about being perfect. It's about limiting the subjectivity w/ sound objective measures and learning the discipline of how to apply this--and then seeing that it is consistently applied. Yes. It's more work. There is the rub.I agree with the spirit of what you're ranting about, but the fact of the matter is that subjectivity and capriciousness are well-known factors in the evaluation of employees in any number of 'mission-critical' fields. Several points on this:
- The problem is not necessarily the subjectivity and capriciousness itself but rather the fact that as residents we have zero rights and can't simply switch jobs/transfer to a different location/whatever if it continues.
- Succeeding in many different careers means knowing how to successfully navigate subjectively graded 'playing fields'. Somebody who has trouble with this consistently probably has much more fundamental issues than the quality of the management above them.
When you know the deck is stacked against you, there's a time where it's definitely better to buck up, shut up, hang low and just muddle through. Causing trouble by filing complaints and lawsuits and generally stirring the pot is like heading off to war in a neon yellow jumpsuit - you're just making a gigantic target out of yourself.
That's not what was said. I get the feeling from your posts that you're misrepresenting and exaggerating things, and this is just one clear example where I can see how you took something someone said and turned it into something else.
Actually I am not, but feel free to feel any way you would like.
Jl Lin, sometimes you are too much. And you clearly don't understand the life of a resident.
OP, good luck child. I was in your shoes for two straight years. We got a new PD mid training who was an evil bitch. A rabid dog. She made my life a living hell for two years. I developed a horrible reputation. Followed by severe anxiety and to this day, I still have to explain my probation to
Credentialing committees and still fight the remnants of anxiety.
Look up my posts circa 2010 thru 2012.
Thankkfully, I found a mentor who thought I was awesome and agreed I was being railroaded by the higher ups, saw a shrink and got on meds, fought with the help of the Union against the planned extension of residency and won, and graduated.
Keep your head down, don't be too vocal like I was about the maltreatment and you can persevere.
FYI, last night I had a nightmare about the evil bitch. More than three years later I still dream about her. That's how much she affected my life.
Jl Lin, sometimes you are too much. And you clearly don't understand the life of a resident.
OP, good luck child. I was in your shoes for two straight years. We got a new PD mid training who was an evil bitch. A rabid dog. She made my life a living hell for two years. I developed a horrible reputation. Followed by severe anxiety and to this day, I still have to explain my probation to
Credentialing committees and still fight the remnants of anxiety.
Look up my posts circa 2010 thru 2012.
Thankkfully, I found a mentor who thought I was awesome and agreed I was being railroaded by the higher ups, saw a shrink and got on meds, fought with the help of the Union against the planned extension of residency and won, and graduated.
Keep your head down, don't be too vocal like I was about the maltreatment and you can persevere.
FYI, last night I had a nightmare about the evil bitch. More than three years later I still dream about her. That's how much she affected my life.
My God chocomorsel, I feel ya. I feel ya. THIS **** HAPPENS UNFAIRLY. IT DOES.
Jl lin, I don't know where academic dishonesty came up in this thread with the OP.
You're right in theory about social change etc, but the stakes are too high in residency. You can't really fight city hall on this one.
I remember back in history where factory and agriculutural workers (a la some Steinbeck novels) started to Unionize and stand up the poor treatment from employers, people working 16 hour day forced to live in way too expensive boarding houses that saw to it they would never save enough to escape to the country to buy land to farm, and what it took for sweeping social change. Strikes can see people homeless. In those times, that sort of social protest saw people DEAD. Union assasinations and the like.
Before I get accused of drama, I mean to say that residency is not as bad to motivate a large movement whereby residents revolts and ditch the hospital on strike, risking making their medical degree worthless without training, financially ruined for life 2/2 debt, and just generally unemployed as it happens. It' s not so atrocious and that people keep coming to work. As far as death, hospital strikes don't happen often cuz yeah, strikers might not die but when depending how much the hospital runs off residents could be a major shut down. Closed hospitals lead to deaths.
People put their head down, get to attending, and the "resident cause" never acted on, because the med students are just worried about getting there and attending is very busy and people just get on with their lives.
Amendment: This thread ran closely w/ another one re: discharge of a MS for wrongly accused academic dishonesty--and a career-killing judgment was given. That one was hard too, b/c the details were not in place. I don't have that feature on anymore that alerts you right away when someone has responded to your response in a thread. I turned it off, but it was getting annoying to me, and I just want to feel a bit more like I can come and go as I please here. So, I think I got a lot of those details twisted in this thread. The same theme is there though, IF things can be taken or vague, face value. The devil is always in the details, so...
At any rate, that person appears to be ousted, and presumably the ousting is completely unjust. Again, don't know if that is so, b/c of lack of details.
But I will still let my response below stand. I am a firm believer that people should be sent packing for measurable, objective cause--and yes, behavioral evaluations get sketchy b/c of their subjective nature; but they certainly can be less so, and this has been done in the workplace in a number of settings. I am pretty darn conservative on a great many things, but I have come to the conclusion that At-Will-Employment is mostly a joke and favors primarily the employer, period. And I do understand that the resident has a contract, but I don't think, particularly since the residency is part of the necessary GME and so forth, that residents should be treated capriciously, especially since, in reality, they are learning and really are functioning under a stipend. I mean you can't have it both ways. You can't say, they are employees, and we can just thrown them the hell out or not renew their contract for weak reasons, especially since this is a vital and imperative part of their education.
Anyway, below is my original reply back to you. Sorry for the confusion.
Well, how does this go against anything I have said? If anything, your situation helps illustrate the importance of my point. Note nuances. I never said jump to any severe response/s. In fact I said I am not at all sure jumping to a severe response was in order, b/c we clearly don't have all the details. I totally understand about the head down thing.
So you would recommend then that people be treated capriciously in an evil, out and out malicious manner, during their education-work experience, with so much on the line? People should just tolerate the Hitlers, even when they have nothing to lose but fight? Although I don't know the gory details of this situation, I think when you have nothing to lose, you have to do what you have to do--especially when the accusation and formal judgment is completely false and there are very limited objective measures in place or there have been pretexts set in place. That's all I am saying.
Other than that, I feel terribly for what you and others have had to go through. I wish I could stop people in positions of power from being total j.o.s. Clearly in the world you can't. When you have to stand and fight, however, particularly if you have nothing left to lose, that's what you have to do.
I am seriously happy you made it through the other side. Abusive, malignant environments destroy learning and negatively impact the profession and those within it When we can do better, we should. All I am saying. Good luck to you.
Jl lin, I meant you are too much as in, good God you type a hell of a lot. Of course I don't advocate for malignant behaviors in programs, but they happen.
The subjective crap is mostly what gets people ousted, fair or not. You can piss of the wrong attending and word spreads like wildfire how horrible you are then of course, everybody puts you under the microscope looking for only the negative ****. Evaluations are such bull****. We should be only graded by how we serve our patients, and how well we know the material. Everything else is fraught with possible drama. If a resident is not running around killing or maimingpatients, and knows the material and shows up to work daily without shirking responsibility, they should not be fired.
A lot of the **** we endure that leads to "Unprofessionalism" issues is just a bunch of ass kissing quite frankly. If you aren't kissing enough of it, brown nosing enough, are a straight forward person like I was, you can rub folk the wrong way and possibly be fired. And of course, if you are a male and Caucasian, you can not show up to work, be a total a sshAt, and still be given the benefit of the doubt much much more than women and minorities especially in the surgical fields.
I had the highest scores on the yearly exam my last two years, was not endangering patients, showed up to work every day on time, did my work, but got lots of negative evaluations because EVERY MISTAKE I MADE was documented, and was looked out for. But like I said, I had a great mentor, and some other attending son my side that really helped me.
It sucks when those higher ups have so much power and can literally ruin your whole life. It happened to a friend of mine. And almost happened to me. One of the reasons they didn't oust me was because she was in the midst of her lawsuit against the department. I doubt they wanted to fire one resident right after another especially when my case wasn't so cut and dried.
I believe he/she is an RN.Where are you at in this process? Are you a resident? An attending? Which specialty are you in?
Yes, she is an RN.I believe he/she is an RN.
Yes, she is an RN.
To get back to the topic, OP, listen to what Perrotfish said. Your MD or DO is essentially worthless without a residency completion certificate. So although your work environment is undeniably unpleasant, and most of us can certainly empathize with you, don't stab yourself in the back just to spite this PD. Keep your trap shut, lower your head, and gut it out, ESPECIALLY if you're in your last year and seven more months of residency is all that's standing between you and that certificate. You've gotten this far. You can take it for a little while longer. Oh, and consider applying for jobs in another region of the country where your PD won't be besties with a lot of people in your field (and you won't run into her at all the small local conferences). Then move on with your life and be happy and successful. Best of luck to you.
I believe he/she is an RN.