Dismissed from 1st year residency. What to do for best outcome?

[DistressedResident]

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redacted

 

[rokshana]

Please help, as I'm desperate and have no clue what to do and I'm afraid of giving too much detail in case somebody identifies me.

The short story is that I am getting dismissed in my first year from my program already. I'm unable to continue due to my performance which I acknowledge that I'm not as good as the other residents and that is an issue I need to rectify. I was previously on probation, so it isn't entirely surprising, but it still hurts. It probably hurts more that I tried so hard and that trying so hard probably made it worse. It feels hopeless and a journey that always is a challenge. All I want to do is help, and instead I'm saddled with over half a million in debt.

I'm completely clueless as to where to go from here?

What are the best steps to protect my future. I still want to practice medicine, but I don't think my chances of getting another residency is likely.

Should I resign?

Is that even an option anymore, since I was on probation?

there have been at least 3 or 4 threads out there that deal with this same topic...i know you think your case is unique, but really, its not...you may have gotten some info from the advice given to those posters.

Being Let Go From Residency

Dismissed from Residency Program 3rd Year

these are locked but still have some info

Dismissed from fellowship and in appeal process.

Fired from residency program. What do I do now?

 

[DistressedResident]

there have been at least 3 or 4 threads out there that deal with this same topic...i know you think your case is unique, but really, its not...you may have gotten some info from the advice given to those posters.

Being Let Go From Residency

Dismissed from Residency Program 3rd Year

these are locked but still have some info

Dismissed from fellowship and in appeal process.

Fired from residency program. What do I do now?

Hi rokshana.

Thank you for sharing that especially since I know it took you some time to do so. I did read those and search the board before posting, but most of them deals with the same recurrent issue which is behavioral problems. Mine is clinical skills and I'm sorry I didn't make that clearer. I'm just scared, alone and desperate. It has been a constant struggle to get to where I am, and this is what I want to do and frankly I have no other options. My debt is over half a million dollars due to this education, and growing every year. I feel like I'm climbing up a mountain with a mountain on my shoulders. It is just depressing and I'm partly in denial to deal with it.

Right now, I have good relationship with the program. It's just I can't keep up, and I want to know if there are things I can do to help me in the future while I'm still in touch with program. For instance, should I ask for a letter of recommendation? I'm assuming they will speak of my troubles, but I have to address that anyhow. I'm hoping they will focus on the positive things about me as well.

I know I need to get better, but how do I recover from this? What specific things can I do?

If I can't get another residency (which is likely) what can I do?

 

[doc05]

What is your specialty? What issues are you having?

You're not even halfway through your intern year... being fired at this point is usually a behavioral issue, as expectations of interns is typically very low. Can you clarify the specifics?

 

[Perrotfish]

Please help, as I'm desperate and have no clue what to do and I'm afraid of giving too much detail in case somebody identifies me.

The short story is that I am getting dismissed in my first year from my program already. I'm unable to continue due to my performance which I acknowledge that I'm not as good as the other residents and that is an issue I need to rectify. I was previously on probation, so it isn't entirely surprising, but it still hurts. It probably hurts more that I tried so hard and that trying so hard probably made it worse. It feels hopeless and a journey that always is a challenge. All I want to do is help, and instead I'm saddled with over half a million in debt.

I'm completely clueless as to where to go from here?

What are the best steps to protect my future. I still want to practice medicine, but I don't think my chances of getting another residency is likely.

Should I resign?

Is that even an option anymore, since I was on probation?

Did you go to a US school? If not, IMG or FMG?

Is this your first residency?

What specialty?

Step scores?

Class rank?

What were the circumstances of your dismissal? Were you accused of drug diversion, criminal activity, or harassment?

Have you officially been dismissed or is that just something you expect to happen in the future?

 

[DistressedResident]

What is your specialty? What issues are you having?

You're not even halfway through your intern year... being fired at this point is usually a behavioral issue, as expectations of interns is typically very low. Can you clarify the specifics?

Family Medicine. The issue is that I wasn't passing my rotation and got placed on probation. I wasn't able to meet their standards. They are telling me there is no way to recover from this at this program.

Did you go to a US school? If not, IMG or FMG?

Is this your first residency?

What specialty?

Step scores?

Class rank?

What were the circumstances of your dismissal? Were you accused of drug diversion, criminal activity, or harassment?

Have you officially been dismissed or is that just something you expect to happen in the future?

Neither. US med. grad.

First residency.

Family medicine.

Step 2 scores in the range of 220-235'ish to give you an idea as the schools probably visit these boards....

I don't think they use ranks, but it there were I probably would be at the bottom. I worked really hard, but I didn't get the same opportunities everyone else did. I had to work hard and basically disown my dysfunctional family to get to where I am.

The circumstances was that I wasn't passing my rotations. They are telling me there is no way to recover from this at this program.

It is official both the dismissal and probation.

 

[deleted480308]

Family Medicine. The issue is that I wasn't passing my rotation and got placed on probation. I wasn't able to meet their standards. They are telling me there is no way to recover from this at this program.



Neither. US med. grad.

First residency.

Family medicine.

Step 2 scores in the range of 220-235'ish to give you an idea as the schools probably visit these boards....

I don't think they use ranks, but it there were I probably would be at the bottom. I worked really hard, but I didn't get the same opportunities everyone else did. I had to work hard and basically disown my dysfunctional family to get to where I am.

The circumstances was that I wasn't passing my rotations. They are telling me there is no way to recover from this at this program.

It is official both the dismissal and probation.

So what is the deficiency? A 220 means you know enough to not get failed. A us med school means you likely speak enough english to communicate.

There almost has to be a behavioral/personality thing going on here (even if you aren’t seeing it). Getting fired 5 months in barely gives them time to get through a remediation process

 

[Perrotfish]

If I can't get another residency (which is likely) what can I do?

This one I can answer now: start over in a new career. You need to get through at least one year of residency to continue with medicine. So that is what you are going to do.

Family Medicine. The issue is that I wasn't passing my rotation and got placed on probation. I wasn't able to meet their standards. They are telling me there is no way to recover from this at this program.



Neither. US med. grad.

First residency.

Family medicine.

Step 2 scores in the range of 220-235'ish to give you an idea as the schools probably visit these boards....

I don't think they use ranks, but it there were I probably would be at the bottom. I worked really hard, but I didn't get the same opportunities everyone else did. I had to work hard and basically disown my dysfunctional family to get to where I am.

The circumstances was that I wasn't passing my rotations. They are telling me there is no way to recover from this at this program.

It is official both the dismissal and probation.

Alright, good news: you will probably get another shot at residency. US grad, no step failures and mid range scores, and no criminal/harassment claims, you are going to reapply for your next cycle. If you apply broadly, and to low tier programs, odds are someone will take you for another residency.

Bad news: You need to not have the same problems next year. This will require some introspection. What went wrong? What went so wrong that you could get fired before December but that you could pass medical school? Just to be clear "not keeping up" or "not passing" are your problems only in the sense that "headache" is a patient's problem. Yes headache is a problem, but several underlying pathologies can cause it and a migraine has a very different pathology than a brain tumor.

Is this a medical issue that you need to fix? Do you need to be on antidepressants? Adderall?

Was it a distraction/work ethic issue? Was something causing you to either come late or leave early? Were there any days that you called out sick? Were there any days that you didn't come in without calling out sick?

Was there a knowledge base issue? Do you need to spend the next 6 months studying?

Is there a different specialty that might suit your pace and personality better? Did you panic during OB emergencies? Were you unable to extricate yourself from patient encounters? Should you switch to Path? Psych? Occ med? PM&R?

You might not be the best person to answer these questions. You are going to need to talk to people you trust. Attendings from both medical school and residency who can sit down with you and give you an honest assessment of your problems and your path forward.

Step one is probably to reach back to the dean of your medical school. One year out your dean would be a good source to help you get your application ready for the next round and also to advise you on where to go next.

 

[SpartanWolverine]

This one I can answer now: start over in a new career. You need to get through at least one year of residency to continue with medicine. So that is what you are going to do.

Alright, good news: you will probably get another shot at residency. US grad, no step failures and mid range scores, and no criminal/harassment claims, you are going to reapply for your next cycle. If you apply broadly, and to low tier programs, odds are someone will take you for another residency.

Bad news: You need to not have the same problems next year. This will require some introspection. What went wrong? What went so wrong that you could get fired before December but that you could pass medical school? Just to be clear "not keeping up" or "not passing" are your problems only in the sense that "headache" is a patient's problem. Yes headache is a problem, but several underlying pathologies can cause it and a migraine has a very different pathology than a brain tumor.

Is this a medical issue that you need to fix? Do you need to be on antidepressants? Adderall?

Was it a distraction/work ethic issue? Was something causing you to either come late or leave early? Were there any days that you called out sick? Were there any days that you didn't come in without calling out sick?

Was there a knowledge base issue? Do you need to spend the next 6 months studying?

Is there a different specialty that might suit your pace and personality better? Did you panic during OB emergencies? Were you unable to extricate yourself from patient encounters? Should you switch to Path? Psych? Occ med? PM&R?

You might not be the best person to answer these questions. You are going to need to talk to people you trust. Attendings from both medical school and residency who can sit down with you and give you an honest assessment of your problems and your path forward.

Step one is probably to reach back to the dean of your medical school. One year out your dean would be a good source to help you get your application ready for the next round and also to advise you on where to go next.

Excellent advice.

 

[PlutoBoy]

This is the third dismissed resident with a username that starts with a D:

Dakota, Diana, Distressed.

Hmmm...

 

[rokshana]

Family Medicine. The issue is that I wasn't passing my rotation and got placed on probation. I wasn't able to meet their standards. They are telling me there is no way to recover from this at this program.



Neither. US med. grad.

First residency.

Family medicine.

Step 2 scores in the range of 220-235'ish to give you an idea as the schools probably visit these boards....

I don't think they use ranks, but it there were I probably would be at the bottom. I worked really hard, but I didn't get the same opportunities everyone else did. I had to work hard and basically disown my dysfunctional family to get to where I am.

The circumstances was that I wasn't passing my rotations. They are telling me there is no way to recover from this at this program.

It is official both the dismissal and probation.

you are a US grad...you got more opportunities the most people. blaming other or stating that you walked uphill both ways to go to school in january is not going to get you anywhere.

you didn't pass you rotations...why? what did they have you do to remediate and why were you not able to succeed?
until you figure that out and fix it so you can reassure another PD that the mistakes at your worst residency won't be repeated.

you probably have a better shot of finding something since its FM, but again, if you don't take ownership of the problems and show what you have done to fix the issues, then i doubt a new place will be willing to take the chance on you.

 

[DistressedResident]

So what is the deficiency? A 220 means you know enough to not get failed. A us med school means you likely speak enough english to communicate.

There almost has to be a behavioral/personality thing going on here (even if you aren’t seeing it). Getting fired 5 months in barely gives them time to get through a remediation process

Can they have an issue with my behavior and not notify me?

Everything is so subjective including passing rotations. However, I know there is a problem with my knowledge so I will address those.

What I sort of need to know is where I'm going and plan accordingly. Also what options are available to me since I'm still on good terms.

 

[mvenus929]

So, for our interns, we just had our first clinical competency committee meeting for them within the last month. Unless you failed your first two rotations and they gave you the same amount of time to turn it around, this story seems suspect.

Why did you fail? Was there patient harm involved? Do attendings not trust you to take care of patients? Most all interns have knowledge issues, but as long as they know what they don't know and work to correct it, it's usually not an issue in the beginning of the year. If you aren't making progress in the second half of the year, sure.

What were your first rotations? What type of program were you in?

You need to figure out if you want to continue to do clinical medicine (in which case, you'll need to reapply for residency with your PD's support and show something that indicates whatever problems you had are actively being addressed). If you don't, then start looking for other jobs.

 

[Perrotfish]

Can they have an issue with my behavior and not notify me?

Everything is so subjective including passing rotations. However, I know there is a problem with my knowledge so I will address those.

What I sort of need to know is where I'm going and plan accordingly. Also what options are available to me since I'm still on good terms.

A few more questions:
1) Were you ever late to work? If so how often (how many days in a normal block)
2) Did you ever call out sick/due to a personal emergency? If so how often?
3) Were you ever out without calling out sick (i.e. you just skipped work)? If so how often?
4) How many patients would you normally see per hour during an outpatient rotation? How many would an average Intern see?
5) How long did it take you to complete you notes (i.e. on average, how many days after a patient encounter would you sign your notes)? How long did it take an average Intern?
6) Did you have an inservice exam? What as your score? What was the average for your class?
7) Did you take Step 3? Did you pass?
8) What rotations did you fail as a residenct? Inpatient? OB? Outpatient clinic? Wards?
9) How late were you usually leaving at night? When di the average Intern leave?
10) What do you mean that you're on 'good terms' with your residency? Is your PD willing to write you a letter of recommendation for another residency? If so would it need to be in another specialty or would you write a letter of rec for family med?

 

[rokshana]

Can they have an issue with my behavior and not notify me?

Everything is so subjective including passing rotations. However, I know there is a problem with my knowledge so I will address those.

What I sort of need to know is where I'm going and plan accordingly. Also what options are available to me since I'm still on good terms.

subjective to a point...and that point is failure. good resident vs great resident vs mediocre resident...sure that can be due to the reputation that you have, but failure of a rotation? Frankly something big had to have happened...you are not telling us the whole story. You have had time to do 4 rotations....what were they? When was the 1st time you were told that something was not right and that if you continued on this path, you would fail the rotation? Were you always late? Notes not completed in a timely manner? complaints from the nurses? insubordinate to your senior or attending? pt found dead in bed when you reported in morning rounds that he was stable with good vitals?

knowledge problems are not going to get you booted in the 1st 4 months.

and options available to you? none if you can't figure out what the issue(s) is(are) and show that you have taken steps to correct then.
Perrotfish has given you some good advice...reach out to someone that you can trust to be able to give you an accurate assessment of you as an intern. If you are on good standing with your PD, then that would be a good place to start, otherwise if there is an attending, or a resident (maybe your chief) that you can talk to...

 

[Apollyon]

And, to ask the harsh question - US grad, sure, but MD or DO? With the proliferation of DO "puppy mills" (got that from SDN), could your guidance have been lacking? I'm not dinging DOs (I'm an FMG), but your story (so far) doesn't jibe greatly with someone who graduated allopathic or went to DMU or COMP or PCOM (examples, not inclusive).

 

[Pes anserine]

Please help, as I'm desperate and have no clue what to do and I'm afraid of giving too much detail in case somebody identifies me.

The short story is that I am getting dismissed in my first year from my program already. I'm unable to continue due to my performance which I acknowledge that I'm not as good as the other residents and that is an issue I need to rectify. I was previously on probation, so it isn't entirely surprising, but it still hurts. It probably hurts more that I tried so hard and that trying so hard probably made it worse. It feels hopeless and a journey that always is a challenge. All I want to do is help, and instead I'm saddled with over half a million in debt.

I'm completely clueless as to where to go from here?

What are the best steps to protect my future. I still want to practice medicine, but I don't think my chances of getting another residency is likely.

Should I resign?

Is that even an option anymore, since I was on probation?

It's odd that you'd be let go when it's barely November - it's only 5 months into the year. Most interns are clueless to some extent and I would say most interns get some sort of a break, especially in the beginning of the year. Did a patient get hurt? Did you get caught doing something wrong - drugs, harassment, serious policy break, etc? It's very odd that you'd be let go so early. Typically when interns are let go it's more of a serious breach than of knowledge or patient care. You are an MD from a US school in a FM program. I don't see if you did not do something egregious why they would be letting you go so early. Maybe it's hard for you to tell us, but without knowing more information it's really hard to assess and to try to help you.
I would certainly say that if your PD is willing to write you a reasonable letter, and you can leave in good terms, that would probably be best. If there is an option of continuing in the program, obviously that would be better but doesn't seem to be the case.

 

[DistressedResident]

I'm getting a lot of questions about what happened, and obviously I cannot go into detail much more as it will likely identify me. I'm not sure what that will do either, because I know I have to fix it. I don't blame them, it's on me. There is definitely some misunderstanding, and my lack of experience in asking for correcting that in documentation and communication didn't help, but I don't think it would have made a big difference. My goal now is to recover from this and improve myself so I can be up to the standards or consider an alternative non residency requirement career.

I'm asking for help to consider options and to preserve any opportunities of the future. If you still feel you need the answer to help me, please ask again and I will do my best to answer it. With that in mind, I really appreciate everyone trying to help me and ask questions. Maybe I can answer some of those questions in a direct message?

The situation is that there is no way for me to continue in the program, and I'm not sure I want to either.

 

[rokshana]

I'm getting a lot of questions about what happened, and obviously I cannot go into detail much more as it will likely identify me. I'm not sure what that will do either, because I know I have to fix it. I don't blame them, it's on me. There is definitely some misunderstanding, and my lack of experience in asking for correcting that in documentation and communication didn't help, but I don't think it would have made a big difference. My goal now is to recover from this and improve myself so I can be up to the standards or consider an alternative non residency requirement career.

I'm asking for help to consider options and to preserve any opportunities of the future. If you still feel you need the answer to help me, please ask again and I will do my best to answer it. With that in mind, I really appreciate everyone trying to help me and ask questions. Maybe I can answer some of those questions in a direct message?

dude... you have been asked a number of times by different people that we need more info to help any further...is this the problem you had? that you don't listen? We, frankly, are not here to beg and plead with you to help you out...many of the people that have posted here are attendings, senior residents or fellows, and even PDs that take time out to post on here.

and like i said in my first post, you are not unique (especially in light of the crazy number of threads on this lately) giving some more details about what got you in this position in the first place is not going to make everyone on here know exactly who you are...while medicine is a small world, its not THAT small.

if someone has asked you a question that you want to answer as a PM, no one is stopping you, but really, what else do you expect people here to be able to tell you without further info.

i'm starting to get a troll vibe here...

 

[doc05]

Granted I have no experience in family medicine, as I'm a surgeon, but I've worked with many residents through the years, and it's UNHEARD of for an intern to "fail" a rotation, let alone be fired, unless its a serious behavioral issue. If you can't share, then we can't give useful advice.

 

[deleted480308]

Granted I have no experience in family medicine, as I'm a surgeon, but I've worked with many residents through the years, and it's UNHEARD of for an intern to "fail" a rotation, let alone be fired, unless its a serious behavioral issue. If you can't share, then we can't give useful advice.

Yeah, my home site has a few residents who openly get called incompetent and struggle to function at even med student level on some off service rotations. They all get passed and moved on because they are super nice, work hard, take correction well and don’t make enemies. Everyone just loves their incompetent a— too much to let a crap rotation or two get in the way

 

[Perrotfish]

i'm starting to get a troll vibe here...

Yeah, I think I am done making posts for these threads.

I'm getting a lot of questions about what happened, and obviously I cannot go into detail much more as it will likely identify me.

I doubt that's true, but if it is? They fired you, what else can they do? And why would asking for options on an internet forum make it worse?

 

[Pes anserine]

I'm getting a lot of questions about what happened, and obviously I cannot go into detail much more as it will likely identify me. I'm not sure what that will do either, because I know I have to fix it. I don't blame them, it's on me. There is definitely some misunderstanding, and my lack of experience in asking for correcting that in documentation and communication didn't help, but I don't think it would have made a big difference. My goal now is to recover from this and improve myself so I can be up to the standards or consider an alternative non residency requirement career.

I'm asking for help to consider options and to preserve any opportunities of the future. If you still feel you need the answer to help me, please ask again and I will do my best to answer it. With that in mind, I really appreciate everyone trying to help me and ask questions. Maybe I can answer some of those questions in a direct message?

The situation is that there is no way for me to continue in the program, and I'm not sure I want to either.

You get asked because depending on the details, it matters what to advice. But given the lack of details (and I in no way want to dump on you or make you feel bad) I would say try to keep the best possible relationship with your program, and have them write you the best possible letter they can. If they can help you find a new residency great. I would suggest maybe more non-clinical things like occupational/preventive medicine. Some of the programs are still out of the match and not that hard to match. Be able to answer clearly and succinctly what happened and how it's been resolved and won't be an issue in the future. Are you getting credit for your first year or is dismissal imminent?

 

[hamstergang]

I'm getting a lot of questions about what happened, and obviously I cannot go into detail much more as it will likely identify me.

Someone who already knows you may identify you here, but then what? Why does that matter?

 

[J ROD]

:troll:

 

[AdmiralChz]

With all of these suspect dismissal threads, it's going to be hard going forward to know who to help. Unfortunate.

Only severe, severe behavioral issues would get a resident fired/dismissed barely 5 months into residency. It'd take the majority of the year for clinical deficiencies.

 

[Apollyon]

Yeah, I'm trying to parse out what is happening. More than 10 years ago, there were some Canadian griefers that tried to make waves, and a few of us took it to them. If there is a concerted effort to troll us, there's very little bang for the buck. The stories are weak and bland, and not very engaging. High schoolers, maybe?

 

[DistressedResident]

redacted

 

[Apollyon]

Yeah, but you offer few specifics. Are you DO or MD? Your grasp of written English seems...tenuous.

 

[DistressedResident]

Yeah, but you offer few specifics. Are you DO or MD? Your grasp of written English seems...tenuous.

I did answer that, as I stated I recently learned there are options for MDs without residency. So I'm MD. Sorry, if it wasn't clear.

 

[J ROD]

I stay in trouble for behavioral issues.....but I clinically am strong so I keep on rolling thus far. I still have not heard of a program placing someone on basically "academic/lack of ability" probation barely a month into residency. I mean everyone is expected to have a grace period at the beginning. Also, usually you have a longer probation period. But at that point you are marked and labeled as incompetent and on the way out the door.