Dissapointing residency evals, advice for improving

[ketameme]

I find a recurrent theme in my evaluations from year to year is that I seem to be behind my classmates in anesthesia knowledge/intraoperative care. This is usually only a few evaluations and the rest say positive things; however, I can't seem to pinpoint exactly where these gaps are. I wish the evals were more specific but they are also anonymous so I'm unable to ask for instances where I was lacking. I do ask attendings I work with for feedback at the end of the day and have yet to receive anything constructive, it's usually "you did great today!" Since my CA-1 year I have made a big effort to be very specific with my anesthetic plans and reasons for doing things a certain way and noting things I will look out for, and how to handle those situations. I'm not sure what else I can do to "prove" my knowledge to my attendings in the OR? If anyone has any advice or been through this before I would appreciate any words of wisdom. I do take these evals to heart and get disheartened despite the fact that I've really been trying.

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[abolt18]

I find a recurrent theme in my evaluations from year to year is that I seem to be behind my classmates in anesthesia knowledge/intraoperative care. This is usually only a few evaluations and the rest say positive things; however, I can't seem to pinpoint exactly where these gaps are. I wish the evals were more specific but they are also anonymous so I'm unable to ask for instances where I was lacking. I do ask attendings I work with for feedback at the end of the day and have yet to receive anything constructive, it's usually "you did great today!" Since my CA-1 year I have made a big effort to be very specific with my anesthetic plans and reasons for doing things a certain way and noting things I will look out for, and how to handle those situations. I'm not sure what else I can do to "prove" my knowledge to my attendings in the OR? If anyone has any advice or been through this before I would appreciate any words of wisdom. I do take these evals to heart and get disheartened despite the fact that I've really been trying.

Not sure if I have much to offer, but I was just thinking about the ways we ask for feedback. "How'd I do?" Or "can I get feedback on how I'm doing?" Doesn't usually amount to anything.

I will say that asking them to give you ONE thing to work on has worked well for me. Sometimes I'll even start the day by asking them to pay attention throughout the day and then give me the one thing to work on or improve at the end of the day. That way they can be watching out for something as we progress throughout the day.

Sorry, it's frustrating to be told you're not doing as well as your peers without being told how to improve or even what to improve. Wish you well going forward.

 

[deleted171991]

Dude, you're clearly weak at anesthesia knowledge. Period. What were your USMLE scores? What are your ITE scores? I would bet they are all pretty low. Even as a resident, I could usually see people like you from a distance; typically, one just needs to read a preop to figure out how much anesthesia (and internal medicine) the author knows. We are the internists in the OR; there is no way around it. People who come from surgical internships are sometimes downright handicapped at medical thinking. One should want to be the guy who's told that their medical knowledge is way ahead of their class.

You need to stop asking questions and start READING. Not big textbooks, but smart medium-sized books (such as M&M and Anesthesia And Co-Existing Diseases) and handbooks (The Anesthesia Guide, The Oxford Handbook of Anaesthesia).. Plus you need to read up for every single surgery, from Jaffe and the handbooks I mentioned.

The problem people in your situation typically have is that they lack the foundations. They typically are weak at basic medical sciences, with a weak frosting of internal medicine on top of it, so they struggle. This is not a house that can stand up to a serious wind of academic inquiry, let's not mention the hurricane that oral boards are. If that's your case, it will be hard work. It's doable, but you will never be an anesthesia rockstar, just a super-CRNA with good people skills. I've seen it, again and again and again, not just in anesthesia, also in critical care, even from people with big names on their diplomas.

I hope I am wrong, and all of these don't apply to you. I am afraid I am not.

If it's not a medical knowledge, it's a personality or creativity problem. Maybe you are a one trick-pony. Maybe you don't try new techniques, new drugs, you're not creative enough. Regardless what it is, YOU need to figure out what's wrong; a lot of faculty doesn't care enough about giving specific feedback because of the eBay syndrome the ACGME geniuses have introduced in the system with their 360 degree-reviews: your attendings review you and you review them, hence they are afraid of payback, especially with generation (wh)Y or Z(ombie, or maybe Zero). Don't expect to get specific reviews at the end of the day, just polite worthless smiles and BS. Dumb people don't appreciate criticism, unless it's packaged with a bow; most attendings don't waste time on useful feedback, because it's just not worth the headache with the tween safe-space toddlers. Stop asking attendings, and try talking to your classmate friends, and see what they are doing differently.

 

[Mikkel]

You don't need to be a brainiac know it all to know everything you need to know.

If you can't adapt your practice to get patients happier, better pain control, less nausea, happier nurses, etc, you don't do well.

Maybe you're really slow in the operating room, maybe you don't have a grasp on pharmacokinetics, maybe you don't know what to do to make surgeons happier.

I hope you can figure it out sooner rather than later, because whatever is going on won't be a benefit to you in private practice.

 

[ambiturner]

A few thoughts:

-the best way to get honest feedback is to ask your attending ‘how would you have done this case differently?’ or something similar. It might still be sugar coated, but they’ll focus on what was lacking, whether bad ideas, poor line technique, etc.

-is communication an issue for you? Language barrier? If not, and you’re having trouble communicating your knowledge, then you need to read more and work on your presenting style. Some people go the other way too and just talk too much or get too specific.

-an appeal to a personal pet peeve of mine: don’t use your cell phone in the OR. It’ll make you pay more attention. If you want to read something print out an article, it’ll look more impressive and you’ll learn something. When cell phone use became acceptable in the OR is a mystery to me and I’ve only been out a few years.

 

[vector2]

I find a recurrent theme in my evaluations from year to year is that I seem to be behind my classmates in anesthesia knowledge/intraoperative care. This is usually only a few evaluations and the rest say positive things; however, I can't seem to pinpoint exactly where these gaps are. I wish the evals were more specific but they are also anonymous so I'm unable to ask for instances where I was lacking. I do ask attendings I work with for feedback at the end of the day and have yet to receive anything constructive, it's usually "you did great today!" Since my CA-1 year I have made a big effort to be very specific with my anesthetic plans and reasons for doing things a certain way and noting things I will look out for, and how to handle those situations. I'm not sure what else I can do to "prove" my knowledge to my attendings in the OR? If anyone has any advice or been through this before I would appreciate any words of wisdom. I do take these evals to heart and get disheartened despite the fact that I've really been trying.

It's not rocket science being an all-star resident.

1. Be prepared for the case (no f'ing duh). Read Jaffee, uptodate anesthesia articles, oxford review of anaesthesia for X or Y procedure. Read Stoelting to know how pts comorbidities X, Y, Z interact with anesthesia.

2. Put some thought into the pre-op, intraop, and post-op management when discussing a case the night before. If we haven't worked a lot together, I need more from you than a text the night before saying "60 yo F, HTN, DM coming for whipple, type and cross, a-line, 2 IV, GETA" so I can determine whether you can think like a physician or you're just coming up with some cookie-cutter anesthesia nurse plan.

3. Get to work early. The best residents set up the OR early, make sure their room is thoroughly stocked, and have a pristine setup. Attendings notice (and get pissed off) when you're missing crucial equipment whose need was previously discussed. Even if something wasn't discussed, use your brain in the AM. If the pt's airway looks more difficult than anticipated or the patient has no veins, I shouldn't have to tell you to grab a glidescope or ultrasound.

4. Learn attendings' personal preferences. Once you're staff, you can do whatever you want to do. In the meantime, if your anal retentive peds attending always wants epi and atropine taped to the top of the machine every time, just do it. If your cardiac attending wants you to clamp your U/S probe cover to the field so it doesn't fall off, just do it. Similarly, make notes about these things so you don't have to get told over and over how to set up. Most importantly, know exactly what your attending wants to be called for each day if there are intraop problems that need management.

5. Practice procedures if you suck at them. If you suck at IVs, get to work early and bang out some first-start IVs in preop. If you suck at ultrasound or fiberoptic or whatever, hopefully you have access to a simulator so you can practice. Otherwise, ask every time if you can try X or Y thing that you are weak in. Ask all the people you work with for tips. Show that you are taking constructive criticism and modify your technique if people who are better than you are trying to help.

6. Be a nice, normal person. Sounds obvious, but there are an unbelievable number of people in the periop setting who are either sociopaths or borderline autistic. Make eye contact, introduce yourself to everyone, be helpful when appropriate, say please and thank you. You wouldn't think I'd have to say these things but you'd be surprised.

 

[dannyboy1]

You are who you are. At this point in the game it’s probably not gonna change. So long as you are on track to graduate random evals from anonymous faculty won’t make any difference in your life. Not everyone can be a superstar taking care of sick @ss cardiac and peds patients (I sure as hell cant). Plenty of jobs out there for generalists......

 

[Lashler9054]

Dude, you're clearly weak at anesthesia knowledge. Period. What were your USMLE scores? What are your ITE scores? I would bet they are all pretty low. Even as a resident, I could usually see people like you from a distance; typically, one just needs to read a preop to figure out how much anesthesia (and internal medicine) the author knows. We are the internists in the OR; there is no way around it. People who come from surgical internships are sometimes downright handicapped at medical thinking. One should want to be the guy who's told that their medical knowledge is way ahead of their class.

You need to stop asking questions and start READING. Not big textbooks, but smart medium-sized books (such as M&M and Anesthesia And Co-Existing Diseases) and handbooks (The Anesthesia Guide, The Oxford Handbook of Anaesthesia).. Plus you need to read up for every single surgery, from Jaffe and the handbooks I mentioned.

The problem people in your situation typically have is that they lack the foundations. They typically are weak at basic medical sciences, with a weak frosting of internal medicine on top of it, so they struggle. This is not a house that can stand up to a serious wind of academic inquiry, let's not mention the hurricane that oral boards are. If that's your case, it will be hard work. It's doable, but you will never be an anesthesia rockstar, just a super-CRNA with good people skills. I've seen it, again and again and again, not just in anesthesia, also in critical care, even from people with big names on their diplomas.

I hope I am wrong, and all of these don't apply to you. I am afraid I am not.

If it's not a medical knowledge, it's a personality or creativity problem. Maybe you are a one trick-pony. Maybe you don't try new techniques, new drugs, you're not creative enough. Regardless what it is, YOU need to figure out what's wrong; a lot of faculty doesn't care enough about giving specific feedback because of the eBay syndrome the ACGME geniuses have introduced in the system with their 360 degree-reviews: your attendings review you and you review them, hence they are afraid of payback, especially with generation (wh)Y or Z(ombie, or maybe Zero). Don't expect to get specific reviews at the end of the day, just polite worthless smiles and BS. Dumb people don't appreciate criticism, unless it's packaged with a bow; most attendings don't waste time on useful feedback, because it's just not worth the headache with the tween safe-space toddlers. Stop asking attendings, and try talking to your classmate friends, and see what they are doing differently.

Just wow man. This is pretty abusive stuff here

 

[deleted480308]

Just wow man. This is pretty abusive stuff here

It’s direct and potentially painful, but so is failing your boards. Sometimes the helpful stuff stings a bit

 

[pgg]

I find a recurrent theme in my evaluations from year to year is that I seem to be behind my classmates in anesthesia knowledge/intraoperative care. This is usually only a few evaluations and the rest say positive things; however, I can't seem to pinpoint exactly where these gaps are. I wish the evals were more specific but they are also anonymous so I'm unable to ask for instances where I was lacking. I do ask attendings I work with for feedback at the end of the day and have yet to receive anything constructive, it's usually "you did great today!" Since my CA-1 year I have made a big effort to be very specific with my anesthetic plans and reasons for doing things a certain way and noting things I will look out for, and how to handle those situations. I'm not sure what else I can do to "prove" my knowledge to my attendings in the OR? If anyone has any advice or been through this before I would appreciate any words of wisdom. I do take these evals to heart and get disheartened despite the fact that I've really been trying.

How is your knowledge base, objectively? ITE and USMLE scores? AKTs (if your program uses them)? Is fact regurgitating really your problem?

Faculty are notoriously bad at giving useful feedback. Few of us have any formal training in how to be educators. Often the vague "behind peers" phrase is the best they/we can conjure to convey discomfort with other, less quantifiable, concerning deficiencies. Things like lack of confidence in their situational awareness, multitasking, priority making, anticipation of events. How do you turn "this guy always looks like a deer in the headlights" into actionable feedback?

If your test scores are poor, and people are telling you that your knowledge is weak, you know what to do.

 

[Lashler9054]

It’s direct and potentially painful, but so is failing your boards. Sometimes the helpful stuff stings a bit

I don’t think he would talk like this to anyone in person. You could be direct without being this harsh. This just sounds bitter

 

[Bryan O’Blivion]

That’s discouraging, but remember that residency is an opportunity to learn. When you get a patient who is scheduled for a surgery, you need to be able to quickly look at the problem list of medical issues and estimate how the disease processes are going to manifest themselves, and how you are going to adjust your anesthetic into the workflow of the surgery/procedure they are getting. It helps to kind of imagine things in a linear manner through time: Are you going to need additional testing to clarify these disease processes? Would it significantly alter how you approach things? Is this a disease process that can be optimized and is this patient at this point? Would premedication be beneficial? Is there a cost/benefit to your premedication? How do you intend to induce and maintain anesthesia in the context of the disease this patient has and the requirements of this surgery? Will you require, or is the situation best served by certain monitors? Are there specific procedures that you intend to use? How well will they work with the patient’s anatomy, comorbidities, and the workflow of the operation? How are you going to plan for emergence and disposition, and optimize the timing and results? Lastly, given what you know about this patient and this operation, what are some things that could go wrong, and how would you recognize/prevent/address them? The goal of your residency is among other things, to be able to ask and answer these questions and synthesize a plan within as much time as it takes to read the H&P and studies. You’ll need to do this about 10 times a day, and where the medical knowledge comes in is filling in the gaps with your working understanding of patho/physiology, your knowledge of the specific situation, and being able to anticipate critical points in the context of that situation. You’ll always be learning, your body of knowledge will never be complete, so get used to the idea that you’ll always be acquiring more knowledge and practicing to quickly apply that knowledge. Sure, bad evals and academic failures sting, but harming a patient through lack of understanding is infinitely worse. Be humble, try to accept that negative feedback is probably the most useful, and seek advice on specific steps to improve.

 

[deleted480308]

I don’t think he would talk like this to anyone in person. You could be direct without being this harsh. This just sounds bitter

And maybe if the OPs attendings were doing this the OP wouldn’t be asking the random internet toguide them

We’re going to disagree on this but the advice ffp gave was useful

 

[GaseousClay]

I don’t think he would talk like this to anyone in person. You could be direct without being this harsh. This just sounds bitter

Yes its much easier to talk like this to someone on a forum. He said stuff that is useful to the OP. Maybe we can create a safespace subforum.

 

[deleted500612]

And maybe if the OPs attendings were doing this the OP wouldn’t be asking the random internet toguide them

We’re going to disagree on this but the advice ffp gave was useful

Perhaps his message was useful and the ultimate point relevant but the delivery was severely lacking. Funny how one of the other posts of advice mentioned avoiding coming across as a sociopath with no empathy or social awareness because that's exactly how the delivery of his post comes across. His lack of tact and smug condescension does not make the advice any more impactful and is completely unnecessary.

 

[Lashler9054]

Perhaps his message was useful and the ultimate point relevant but the delivery was severely lacking. Funny how one of the other posts of advice mentioned avoiding coming across as a sociopath with no empathy or social awareness because that's exactly how the delivery of his post comes across. His lack of tact and smug condescension does not make the advice more impactful and is completely unnecessary.

^^^^this.

Every other poster of advice was able to do so without seeming condescending or abusive like FFP. OP needs to read, but it’s really easy to communicate without being a sociopath.

 

[deleted162650]

 

[deleted480308]

Perhaps his message was useful and the ultimate point relevant but the delivery was severely lacking. Funny how one of the other posts of advice mentioned avoiding coming across as a sociopath with no empathy or social awareness because that's exactly how the delivery of his post comes across. His lack of tact and smug condescension does not make the advice any more impactful and is completely unnecessary.

^^^^this.

Every other poster of advice was able to do so without seeming condescending or abusive like FFP. OP needs to read, but it’s really easy to communicate without being a sociopath.

Your emotions are causing some hyperbole here

 

[deleted500612]

Your emotions are causing some hyperbole here

Not emotional in the least. If you've seen my other posts on this forum you'll know I'm definitely not a defender of snowflake culture, but I do believe that the delivery method of criticism and feedback is just as important as the content itself. If you believe in evidence based education you don't have to look far to know that gratuitous belittling of your subordinates results in worse educational and performance outcomes. There is literally not a single benefit of delivering your feedback in such a way other than feeding your own ego at someone else's expense. pgg managed to address most of the same things in his post without being a needless dick about it. It's called basic decency.

 

[deleted480308]

Not emotional in the least. If you've seen my other posts on this forum you'll know I'm definitely not a defender of snowflake culture, but I do believe that the delivery method of criticism and feedback is just as important as the content itself. If you believe in evidence based education you don't have to look far to know that gratuitous belittling of your subordinates results in worse educational and performance outcomes. There is literally not a single benefit of delivering your feedback in such a way other than feeding your own ego at someone else's expense. pgg managed to address most of the same things in his post without being a needless dick about it. It's called basic decency.

“Sociopath” is hyperbole here

 

[deleted500612]

“Sociopath” is hyperbole here

Sure, but still sociopathic/cluster B personality traits. Ironically people who most readily and unabashedly belittle and condescend others in such a way are nearly invariably the first to get absolutely irate and extremely defensive if someone dared criticize and demean them in the same way. It's typical cluster B.

 

[deleted162650]

There is literally not a single benefit of delivering your feedback in such a way other than feeding your own ego at someone else's expense

Disagree. 5yrs from now, whose advice do you think the OP is gonna remember - @pgg ’s or @FFP ‘s

 

[deleted171991]

Trigger warning: this post may contain strong language, AKA as THE TRUTH. Please do not read it outside of your safe space. Please make sure to put on your psychological safety belt, maybe gather together with other sensitive souls, to comfort each other and protect your feelings from getting hurt.

First of all, I am half sorry half not for the OP. I have walked in those shoes, maybe a different model, until the grapevine was so kind to tell me what one of the attendings had said about me. Nothing to be proud of. That was a wake up call.

While a resident, I used to hate working with a couple of attendings, including that one, because they were not nice to me. They were in your face, and told you (occasionally) exactly what they thought about you. Many years later, I mostly remember just what those people taught me.

Those who read this forum frequently know that I believe in tough love, especially in education. It's been proven again and again that memories are best formed when coupled with strong emotions. That's why the sergeant shouts at the fresh recruits in the military. I still have to see a good professional sports coach who doesn't occasionally raise his/her voice and make players feel bad. If one is comfortable, one is not learning.

The reason I was half not sorry for the OP was that one should know by the middle of the CA-2 (or CA-3?) year what one sucks at. It shouldn't be rocket science by now. If one doesn't have that kind of insight, it ain't good and won't end well. It's one thing not to be good at something; it's a different story not even knowing what one doesn't know. That's a royal lack of insight. And that was the part that pissed me off enough to kind of go off on a rant at some point.

By the way, that post was written while tired, hence my filters were not working well anymore (then, on top of that, I wasted 20+ minutes to give him advice, like any respectable sociopath). Still, some reactions to that post made me think QED. I couldn't have brought on the postmodernist whining better even if I had wanted to. Some people just couldn't help themselves and had to prove my point that one cannot tell the truth to some Y-ers and Z-ers without packaging it in a lot of lies, with a bow. It's not worth the effort, and it's not worth the consequences, and here's the proof. Also, it was symptomatic that the people who were so fast at being speech police did not contribute sh-t to the thread. If you disagree with what I said, at least do a better job than me, so I can admire the genius of your thoughts, the beauty of your minds. Don't just criticize me with the IQ of a mob, i.e. the reptilian brain, the limbic system. There is no cortex involved there.

As things stay, I am afraid for the future of this country and of the world. My only hope is that these generations will mature, as we all have. We have all been there. In the meanwhile, dear snowflakes, if you can't forgive my bluntness, please just Ignore me. It takes just a click, the same one I will use for ya.

Love, "Boomer". OK?

P.S. I've just re-read my previous post. THAT was sociopathic? Seriously? Holy cow, what babies! That post is almost civilized (as in yes, I would say all that to your faces, if I actually cared about your welfare). Please do yourselves a favor and grow up. You can start by reading "The Coddling Of The American Mind".

 

[deleted500612]

Disagree. 5yrs from now, whose advice do you think the OP is gonna remember - @pgg ’s or @FFP ‘s

5 years from now? To be honest probably neither. Not like this is some profound life changing advice.

 

[MoMoGesiologist]

If you separate the emotional component from the content, FFP gave very good advice. Also, the fact he took time to write all that is dedication to education. It may be mean, but for your education, it’s better than the attending who gives you all five stars and says nothing constructive.

Now that I’m done with residency, I’m learning it’s just as hard if not harder to give feedback. Most people don’t ask for feedback (haven’t been asked by a resident yet for it). Most people I don’t think want it. No one wants to hear something negative. But how can you grow and get better if you don’t know you are doing something that can be improved? You just get pushed along, not being helped to reach your full potential.

OP, keep asking your faculty in direct conversation how you can improve. They will respect that and want to help you.

 

[caveat87]

I agree that the most memorable teaching moments in residency were when I messed up/wasnt prepared and the attending leaned into me hard. While it is unpleasant at the time, the reality is one day your ass is going to be on the line and nobody is going to be able to save you when you didn't bother to check your equipment/drugs and your laryngoscope fails down in offsite hell. I know for a lot of CA2 into CA3 year I was jaded about "learning" as I sat stool for endless hours but there is a lot that you pick up with reps.

That being said OP, I'm recently out of training and I did find rather generic statements about "you are better than most in your class...or you are weaker than most" to be pretty worthless. I also do feel that to some extent residency was a popularity contest and there were definitely "the chosen" and "the targeted". You can avoid being the "bad resident" by working hard and showing up early, paying attention during cases and reading often, asking questions to your attendings or discussing relevant articles/issues/topics, and having a good attitude. You can definitely talk to your program director as well since I guarantee faculty members that are less than pleased with certain aspects of your performance will talk with him/her. Ask for specifics and clarification, especially from your more critical attendings.

 

[DrOwnage]

I feel for you man. I'm neurotic about my reviews. I have had mostly positive reviews, but I had one bad review that was the kicker. Even though these evaluations are "anonymous" I knew exactly who the attending was who wrote it by their tone and diction, and the issue that possibly led to it. It was just a moment of me questioning whether to give a higher dose of labetalol because the patient was extremely hypertensive (230s/120s) during a trigeminal ballooning. She must have been having a bad day and the stars aligned. She wanted me to give 5mg and I was like I think we need to give a higher dose and she snapped on me. Got a paragraph review 2 days later "anonymously." Very bad stuff, sounded like she finished the day at 5pm and sat in her office for 45 minutes using a thesaurus to write this thing. It really got to me for a month or so. However I never confronted the attending, I just worked to improve myself, kept a little more to myself and have tried to sound more polite when responding to attendings (asking them to explain their logic, rather than politely disagreeing with them).

Worked with the same attending recently and I freaking murdered the day. Spent extra time with the preop evals, got there 30 minutes earlier, slayed lines and patient management and was very polite even though I knew they had written those things in the past. The attending was very forward about how good of a job I did and said I had a very bright future, said some kind words about findings jobs and such. Almost as if they had forgot about everything.

What FFP is saying is right (albeit could be said a little differently). Even though I didn't think I deserved what was said, I improved a lot from that criticism because it pushed me to be better and prove that person wrong af. I've never improved from a review saying "good airway management" or "keep up the good work."

 

[abolt18]

I seriously love this place. I initially found @FFP to be very abrasive but I've grown to welcome his perspective and candor. It's refreshing when others dance around issues.

 

[AKMD_1984]

talk to pd, find a mentor.

 

[dchz]

Yes its much easier to talk like this to someone on a forum. He said stuff that is useful to the OP. Maybe we can create a safespace subforum.

It's important to establish a safe word. I do not recommend using "FFP" as a safeword.

I seriously love this place. I initially found @FFP to be very abrasive but I've grown to welcome his perspective and candor. It's refreshing when others dance around issues.

I did the opposite. I loved his perspective and candor, eventually felt he's kinda over the top. I don't talk like him anymore because I found I've made WAY MORE friends that way. But unfortunately i still think like him...

The SUPER CRNA stuff he says is so prevalent yet sad for our profession. I started out my residency by asking "why?" a lot. It made it seem like i came from a place of ignorance, but several attendings quickly found out that was my very subtle lead in into what they were doing wrong. I DO NOT recommend this method. I had to learn the hard way. But i was quick enough realize which ones i discussed theory and improve my practice and which ones i smile and say "yes sir" or "yes ma'am" and just made sure the patient didn't get harmed.


My advice to OP:

First, you should thank the attending. No matter how bad the advice was, I can assure you it wasn't easy to give. They took on some discomfort for your benefit. Be thankful.

Second, you gotta be honest with yourself. Make sure there is some truths in the claims (otherwise laugh at the ridiculousness). Take a second to let yourself feel a little down, even the ones that take criticism really well still feels down after some good feed back. I know i'm not god's gift to anesthesia, but I still feel disappointed if I didn't do something well. To do so is to be human. It also means you have some self-esteem and hold yourself to a certain standard. Step 2 seems silly, but I find this is the reason a lot of feedback falls on the deaf ears. It is the reason @FFP 's sound advice is so poorly received.

Then, take the message and leave the emotions, be thankful you got the message before it was too late to change. You have dealt with the emotions, now make some specific, measurable, achievable, relevant, and timely goals to be a little bit better. (examples given in @vector2 's replies) Rome wasn't built in a day, you're not gonna be a rockstar overnight. But all the rockstars did this some point in their career. You are now on the same path as the rockstars that "ahead" of their peers. Who knows, you might surpass that attending and the rockstars someday. 😉

 

[deleted171991]

@dchz, if my memory serves me right, you have a beautiful mind and an excellent knowledge of medicine. If I didn't give a crap about you, I would have encouraged you to go into critical care asyour first choice. You tend to ask the right (i.e. hard) questions and find interesting answers to them. Please do keep asking Why?, just make sure you ask the right people, those who appreciate that question. I appreciate every trainee who asks me something intelligent I don't know and pushes me out of my comfort zone (although I hate the sensation). I think your attendings should feel honored they get to teach you; you have probably realized that most don't. Also, don't put anybody on a pedestal; the higher the pedestal, the greater the fall.

Btw, I don't think I'm God's gift either, not even in critical care. If anything, I have impostor syndrome. Unfortunately, I see so much iatrogenic stuff it's really hard not to be frustrated. When a know nothing anesthesiologist like me correctly diagnoses a common pulmonary condition the big name pulmonologist misses for a zebra, I get pissed. I am average or less than in most things I do (the only thing above average are my knowledge of basic sciences and my instincts), but, God, I hate the knee-jerk medicine that surrounds us (and I care about my patients, even as a cynic). That's all. And that makes me irreverent towards people who choose to practice medicine but don't bother getting decent at it, the super-midlevels. Healing is an honor, and the patient-doctor relationship is a bond of trust.

Sorry for the occasional intensity of my posts. We live in a culture where it's so much easier to just keep silent and/or agree. "Speech was given to man to disguise his thoughts." Unfortunately, I have never been really good at politics, and I have paid the price. "Yes, sir/madam" and butt-kissing will always take you further with average (i.e. most) people. Dale Carnegie was right. That does make me bitter, having been raised in a meritocracy; the world is anything but.

And to the user who compared me to @pgg: he's a better (both humanly and professionally) and wiser person than I am. Apples and oranges.

 

[deleted171991]

If you separate the emotional component from the content, FFP gave very good advice. Also, the fact he took time to write all that is dedication to education. It may be mean, but for your education, it’s better than the attending who gives you all five stars and says nothing constructive.

Now that I’m done with residency, I’m learning it’s just as hard if not harder to give feedback. Most people don’t ask for feedback (haven’t been asked by a resident yet for it). Most people I don’t think want it. No one wants to hear something negative. But how can you grow and get better if you don’t know you are doing something that can be improved? You just get pushed along, not being helped to reach your full potential.

OP, keep asking your faculty in direct conversation how you can improve. They will respect that and want to help you.

They absolutely don't want it. I have a lot of respect for trainees who have the guts to ask for feedback, especially after a bad day. "Forgive me father for I have sinned..." We live in a culture and a specialty that sees it as a sign of weakness (fake it till you make it), which is extremely dangerous in medicine. I have worked with CA-3's I wouldn't have allowed to take care of my loved ones, and yet they didn't ask about suggestions for improvement at the end of the day, and got pissed when I intervened to protect the patient (and my license) from their stupidity. I am all for learning through making mistakes, but those had better be overthinking and not "underthinking" mistakes. Common sense is not common.

Also, I don't think a faculty member has ever gotten a good review for pointing out a trainee's mistakes. 🙂

 

[Iso4ane]

To improve oneself, one must know what one is lacking. One should always have a reason for what they do (even if that reason is not very good) like how you tie your shoes (which in fact turns out has a correct and wrong way of doing it). Which leads to asking a lot of why questions and self improvement (e.g when I learned to tie my shoes correctly).

 

[DocVapor]

Also, I don't think a faculty member has ever gotten a good review for pointing out a trainee's mistakes. 🙂

This isn't true. I've purposefully praised attendings on my evaluations of them specifically because they pointed out my mistakes, pushed me to do better, and didn't treat me with kid gloves. Even the ones where after further research I ultimately disagreed with their reasoning. Now I am a non-traditional that had demanding jobs prior to medicine, and my father was a military officer, so this is what I'm used to. I graduate in 188 days. I'm not anywhere close to being a rockstar resident, but I have true millenial juniors beneath me who are, and they do crave the real, meaningful feedback. So for any attendings who might be starting to give up on the current generation for whatever reason, please don't.

 

[JOHNBROCHILL]

I feel for you man. I'm neurotic about my reviews. I have had mostly positive reviews, but I had one bad review that was the kicker. Even though these evaluations are "anonymous" I knew exactly who the attending was who wrote it by their tone and diction, and the issue that possibly led to it. It was just a moment of me questioning whether to give a higher dose of labetalol because the patient was extremely hypertensive (230s/120s) during a trigeminal ballooning. She must have been having a bad day and the stars aligned. She wanted me to give 5mg and I was like I think we need to give a higher dose and she snapped on me. Got a paragraph review 2 days later "anonymously." Very bad stuff, sounded like she finished the day at 5pm and sat in her office for 45 minutes using a thesaurus to write this thing. It really got to me for a month or so. However I never confronted the attending, I just worked to improve myself, kept a little more to myself and have tried to sound more polite when responding to attendings (asking them to explain their logic, rather than politely disagreeing with them).

Worked with the same attending recently and I freaking murdered the day. Spent extra time with the preop evals, got there 30 minutes earlier, slayed lines and patient management and was very polite even though I knew they had written those things in the past. The attending was very forward about how good of a job I did and said I had a very bright future, said some kind words about findings jobs and such. Almost as if they had forgot about everything.

What FFP is saying is right (albeit could be said a little differently). Even though I didn't think I deserved what was said, I improved a lot from that criticism because it pushed me to be better and prove that person wrong af. I've never improved from a review saying "good airway management" or "keep up the good work."

Based on this I’m not sure your anesthesia skill set or knowledge improved at all. Just your ability to “yes sir, no sir” which undoubtedly makes you look better to attendings. After all how dare you question giving 5mg labetalol. All I can say is she sure whipped you into line.

I didn’t often challenge my attendings plan if I think it made no clinical difference, and I also got great reviews as a resident.

”wow that really is a great way to tape the eyes closed. Thank you for showing me!”

“You want me to give 1.8mg versed? That’s a great dose, let me get out the tb syringe.”

For OP sometimes the game is sucking up and sometimes the game is at least appearing to know your stuff. If the evals and feedback is very nonspecific there may be a component of the way you hold yourself. How are your ITEs?

 

[Iso4ane]

The ITE is one objective way of evaluating residents and doing well (not just okay) can definitely make life easier (not only is your foundational knowledge better) but your attendings tend to give you more leeway too.

 

[killerleaf]

As someone who has sat in numerous CCC meetings, a slightly different viewpoint. This is based on my experiences, but maybe they can help.
1. "not as far along as the rest of the class" uh, we had a class that was made up of mostly rock stars--thru the roof step scores, ITE's...so those that were just a little below them were seen as "not as far along..." even tho they were actually way above average (and in a different class would have been the "rock stars"). The PD took those faculty aside, and made them realize that the residents were, in fact, doing very well. Sometimes faculty needs that perspective.
2. We once had a resident that was very deliberate in his speech. If asked a question, he would seem to hesitate before answering. Faculty gave negative evaluations, even tho the answer was usually correct. The PD stepped in--the resident explained that he was trying to make sure he was saying the correct thing before speaking. He went to a therapist for a few sessions, (speech), and worked with one of our faculty who was big into Toastmasters. This helped tremendously--and no more negative evaluations. And, he passed his Oral Boards on the first try. (he was worried about it, but did a ton of "mock orals" beforehand.
3. There was one faculty whose evaluations were discarded at the meetings, and not credited. The hallrunners tried to make sure he had solo rooms, with no residents, because he was great at the job, sucked at being an educator. Everyone knew that he would nitpick, and complain about minutiae that nobody cared about. (I kid you not, one evaluation complained that the resident's scrub pants were too short, he could see the top of their socks. Please keep in mind we have a scrubex system, it was not like the resident had a choice as to the fit...because they all fit funny.)

I would suggest going and speaking with your Program Director. I am sure that they would have insight as to what these evaluations (and the evaluators) are looking at/for. They would also be able to give you direction in getting these turned around.

 

[Aether2000]

My suggestion: dig deeper. Don't stop with knowing the technical aspects of delivering anesthesia- that is relatively easy. Dig for knowledge, looking at the history behind a certain technique, tools, equipment, and dive into to details and trivia about medications and how things work. Discover the joy of anesthesia- hint: it is not in the performance of a perfectly executed anesthetic. If you are enthusiastic and are ever seeking to go beyond the text books in your pursuit of knowledge, your attendings will notice.

 

[SingfrAbsoltion]

="FFP, post: 21477711, member:

Also, I don't think a faculty member has ever gotten a good review for pointing out a trainee's mistakes. 🙂

That’s so not true. I’ve written “I appreciate the brutal honesty” without sarcasm and gave the attending a good evaluation. If they teach me I appreciate it. But then you have the ones who go all hulk on you and if you ask them a question respond with “go read” or “you should know this”

I have mixed feelings about advice in this thread. I used to get lukewarm/mixed evals but after I started subspecialties I found ones that I loved and think my enthusiasm helped with attending interactions.

 

[Gern Blansten]

I would like to write in support of FFP. Having been on this forum for a while, he offers some of the best advice. It may not always be packaged in a way that makes you feel good, but 95% of the time, it is great advice. Everyone needs to hear that kind of advice at some point in their life. Someone who cuts through the garbage and gives it to them straight. That is really hard to do as an educator because it is a fine line between giving someone the criticism they need to hear versus a beat down that they can't recover from. Learners need someone to knock them down a few pegs periodically and they also need someone who can pick them up from failures, dust them off, and let them know that they will recover from whatever problem it is. Very rarely, you have a learner that everyone knows will not be successful. Even more skill is needed to get them to the point where they can see it as well, without completely breaking them. Being an educator can be very challenging and it is good to have a mix of different types of educators in your faculty. There are some faculty that serve only to show their trainees how not to do something. As much as we try to minimize that aspect and weed out those types, there can be value in that as well.

 

[deleted171991]

Trigger warning: brain will hurt from thinking, IQ will turn positive.

Let me rephrase what I said: one will get far more positive reviews if one treats mistakes in a casual manner, and pampers the babies, caresses the egos. Just look at this forum, or at this thread!

You're a CA-3, you arrived late, and your room was not set up properly... no biggie.
You're within 3 months of graduation and you can't do an ambulatory case solo in an ASA 2... no biggie.
You're a senior resident who just sits on his butt and can't tell me the current blood loss level in a major case, let's not mention keeping up with it? (Not with pressors!!!) No biggie.
Etc.

Generally, you're just another cocky youngster who lacks knowledge and/or judgment and/or a conscience and (especially) a dose of humility, and I wouldn't let you take care of my family, even under supervision? No biggie.

To be fair, these only apply to a handful, like malpractice lawsuits. Still, the latter dictate our defensive medicine, and the former our defensive teaching. 😉

The fact that our education is NOT working is proven by teachers not giving frequent feedback, like coaches, in (almost) real time: that's not sniffing position, hold the mask like this, don't waste time on that, you need to open the mouth more, stop leaning forward etc. Hence trainee improvements are few and slow. But that's how this generation probably likes it.

If I were you, I would want a good coach who almost breathes down my neck; stressful like hell, but extraordinarily educational. It's not the 10,000 hours of practice that make the expert. It's the thousands of hours spent on unlearning mistakes until there is none left, and conscious, targeted, analyzed in painful detail by a supervising master, practice.

 

[deleted875186]

Great advice above. As a CA3 I can offer my point of view.

I try to take all feedback seriously. If I think someone is giving me feedback or telling me to do something that I disagree with, I check myself first. Ask why, understand their point of view, take it as an opportunity to learn. I ask for real time feedback throughout the day, even than it is difficult for attendings to give good feedback. If there is non specific negative feedback in an eval that you are unsure of where it came from, I would talk with your PD first to get perspective.

Are you a quiet person? You may have to talk more with your attendings. It’s not like internal medicine where the attending can read your notes or hear you present a patient on rounds or hear your plan for the patient, you may have to verbalize more during the day.

 

[DrN2O]

To OP, talk to your PD or chair of CCC stat. If your "year to year" comment is accurate, that means you have been on the CCC radar for some time. The next action may well be a formal letter. This will go on your record and binds the PD's hand when writing letters for jobs and fellowships and no one takes this step lightly. Maybe everything is fine, you are just below average from a class of rock stars, and they will reassure you. But the opposite is very bad, and by the time you are a CA-2, the clock is running out. You get put on probation for 6 months, now you are going into your last year. They can 1) have your residency extended, 2) fired, or 3) take off probation, and have you limp to the finish line and hope for a job taking care of ASA 1/2.

For all the CA-1s, don't read the positive evals. Everyone gets those, they are mostly worthless, only good for your graduation when your PD wants to say something nice. Are you bad at procedures? Learn from your complications, replay the steps, ask feedback and change. Is your scores low? Read the basic textbooks, and get better scores. Are you slow making decisions in the OR? Talk out what you see, your thought process and ask your attending if your DDx is correct. Is your personality introvert, shy or just don't click with the attending or surgeon? Break out of it, get a mentor or a therapist. Do you lack insight into your problem because the eval are useless? That's the faculty's fault. We are bad at it, and most people don't say anything when there's nothing nice to say. Are you all of the above? Now that's difficult, because you don't get the benefit of doubt as someone with 99% ITE, or an outgoing likable personality.

Finally, not everyone is meant to be an anesthesiologist.

 

[MoMoGesiologist]

Did OP say what his ITE scores were yet? Need those to help you identify your problems. Also your SSN

 

[IkeBoy18]

who almost breathes down my neck; stressful like hell...

I agree with this whole post but the above. It’s probably good for most but I never liked this sort of style. I’m sure it works for some and not needed for others.

I made top 95+ %tile every ITE, always read a lot and was pretty well liked among the faculty. We had maybe. A couple of attendings that breathed down your neck and tried to make things stressful but I found it more annoying and unnecessary. I learn much more and am in the mindset to learn without all the histrionics.

 

[DM27]

I don’t know if you are a CA-2 or CA-3 currently, but if you’re a CA-2 there is still time. If you have otherwise unimpressive scores up to this point just study your ass off for your ITE and try to demolish it. It won’t make you a better clinician or a resident but it will likely get people off your back.

If you’re a CA-3 it’s probably too late to substantially change anyone’s impression of you and I assume any job or fellowship situation is largely sorted out at this point.

I also wouldn’t fully put it past your attendings to be judging you more based on your test scores (if they are poor) than your actual demonstrated knowledge. Test scores in medicine are a lot like wealth in real life where they are the difference between being crazy vs. eccentric.

 

[abolt18]

I don’t know if you are a CA-2 or CA-3 currently, but if you’re a CA-2 there is still time. If you have otherwise unimpressive scores up to this point just study your ass off for your ITE and try to demolish it. It won’t make you a better clinician or a resident but it will likely get people off your back.

If you’re a CA-3 it’s probably too late to substantially change anyone’s impression of you and I assume any job or fellowship situation is largely sorted out at this point.

I also wouldn’t fully put it past your attendings to be judging you more based on your test scores (if they are poor) than your actual demonstrated knowledge. Test scores in medicine are a lot like wealth in real life where they are the difference between being crazy vs. eccentric.

I honestly don't even know if our faculty know our scores? It's never really talked about.

 

[Status Sciaticus]

I honestly don't even know if our faculty know our scores? It's never really talked about.

From what I've seen and been told, most academic departments is like high school: you have your cliques, and people tend to gossip which includes your ITE scores and what they think of you.

 

[AdmiralChz]

From what I've seen and been told, most academic departments is like high school: you have your cliques, and people tend to gossip which includes your ITE scores and what they think of you.

In most academic programs, those at the “bottom” stick out way, way more than those at the top. Especially those with marginal ITE/board scores. Those at the top are lauded, and those in the middle/OK scores just sort of coast through.

 

[dannyboy1]

From what I've seen and been told, most academic departments is like high school: you have your cliques, and people tend to gossip which includes your ITE scores and what they think of you.

So long as you are on track to graduate, who gives a fu(k? I had the occasional snarky comment in my evals as a resident, nobody but the program director sees it. When you graduate you just get a certificate that says you completed residency in good standing. Nobody at any job I applied for asked to see evaluation comments....