Drowned... now what?

[niceguydoc]

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kinda sounds like my program kungpow

 

[lvspro]

What a lousy situation. Unfortunately, from what I've seen at my program, it takes a LOT to get booted from a program. I think programs have to report their matriculation rates to acgme, and if low, they get dinged, and inspected, so that would be 1 motivating factor to keep poor residents. So, if a program is willing to risk it's licensure by booting someone, then it better be a pretty durned good reason. I've heard of people getting booted from ours, but they were for things like having sex with a pt, showing up to work on oh/illicits, assault and the like. I think you should re-evaluate yourself/capabilities and then choose your career accordingly. Gas ain't for everyone.

 

[radslooking]

Sometimes it actually is the system, though.

-copro

true. but if that's the case then you have two choices, leave or stick it out. i don't think that's this poster's problem though, i think it's just exacerbating it. It seems like there are specific, recurring problems that she isn't addressing.

 

[coprolalia]

but if that's the case then you have two choices, leave or stick it out.

I think this is a bit of a false dilemma, and there are really more choices. Likewise, I don't think that you can always "leave" as easily as people make it seem. Escapism sounds good in theory, but you have contracts, leases, paper trails, etc. that are hard to run away from.

I think a better remedy would've been to address this earlier on after the first "unsatisfactory" evaluation (junior residents take note). What you do is send a very apologetic email to your program director outlining the fact that you are bewildered as to why you got an unsatisfactory. You contritely ask for them to provide specific instances where your performance was deficient so that you can learn from them.

This serves two purposes. First, it requires that they directly address with you perceived deficiencies, in writing, to which you can further respond in writing with your own impression of the instance. At this point early on, you can actually learn from this instead of guessing why no one seems to like you. Second, it allows you the opportunity to start documenting your concerns so that when they fire you in CA-3 you have a record of the specifics (or, as the case may be, non-specifics) that can form the basis of your complaint to the ACGME/ABA (etc.) or an employment attorney.

The point is, you have to be proactive. It's your own career and livelihood you're looking after. The sad fact is that most physicians, even those who purport to be educators with your best interests in mind, are horrible managers with a lot of theory but usually no skills in actually developing people. The strange irony is that these same people often perceive themselves to be quite good at it.

You can let them be lazy and try to pass off opinion and innuendo as professional development. But, then you only have yourself to blame.

-copro

 

[michgirl]

I think this is a bit of a false dilemma, and there are really more choices. Likewise, I don't think that you can always "leave" as easily as people make it seem. Escapism sounds good in theory, but you have contracts, leases, paper trails, etc. that are hard to run away from.

I think a better remedy would've been to address this earlier on after the first "unsatisfactory" evaluation (junior residents take note). What you do is send a very apologetic email to your program director outlining the fact that you are bewildered as to why you got an unsatisfactory. You contritely ask for them to provide specific instances where your performance was deficient so that you can learn from them.

This serves two purposes. First, it requires that they directly address with you perceived deficiencies, in writing, to which you can further respond in writing with your own impression of the instance. At this point early on, you can actually learn from this instead of guessing why no one seems to like you. Second, it allows you the opportunity to start documenting your concerns so that when they fire you in CA-3 you have a record of the specifics (or, as the case may be, non-specifics) that can form the basis of your complaint to the ACGME/ABA (etc.) or an employment attorney.

The point is, you have to be proactive. It's your own career and livelihood you're looking after. The sad fact is that most physicians, even those who purport to be educators with your best interests in mind, are horrible managers with a lot of theory but usually no skills in actually developing people. The strange irony is that these same people often perceive themselves to be quite good at it.

You can let them be lazy and try to pass off opinion and innuendo as professional development. But, then you only have yourself to blame.

-copro

That was EXACTLY what I did. From the first months of CA1, when I started to feel it, I was trying and trying to get SPECIFIC feedback... The most specific points I got was "you shut up and do you job" or "you know, there's maybe something about atmosphere in the room what he/she feels wrong with you". Over CA2 year, got tons of reassurance that I'm doing just fine. There were NO episodes like sleeping with someone, missing drugs, ets (I know that it's only my words but I wouldn't be here, otherwise).
And, needless to say, OR teaching doesn't exist there.

Above was a point about me possibly being too much focused on minor details and kind of obscessive-compulsive. That's true. It's the prompt result of, for example, The Powerful Attenging roaring in front of me that, if next time he sees me refilling propofol without gloves, he will crush my stupid head against the wall. As well as circulators rummaging in my room in hope to find an unsigned syringe and thus please The Powerful Guy beyong all means.

My main mistake was that I didn't leave the damned place after CA1 by my own will and continued to bump my head against the wall in attempt to "please" The Powerful Guy and his cronies. OK. Another lesson learnt.

 

[toughlife]

That was EXACTLY what I did. From the first months of CA1, when I started to feel it, I was trying and trying to get SPECIFIC feedback... The most specific points I got was "you shut up and do you job" or "you know, there's maybe something about atmosphere in the room what he/she feels wrong with you". Over CA2 year, got tons of reassurance that I'm doing just fine. There were NO episodes like sleeping with someone, missing drugs, ets (I know that it's only my words but I wouldn't be here, otherwise).
And, needless to say, OR teaching doesn't exist there.

Above was a point about me possibly being too much focused on minor details and kind of obscessive-compulsive. That's true. It's the prompt result of, for example, The Powerful Attenging roaring in front of me that, if next time he sees me refilling propofol without gloves, he will crush my stupid head against the wall. As well as circulators rummaging in my room in hope to find an unsigned syringe and thus please The Powerful Guy beyong all means.

My main mistake was that I didn't leave the damned place after CA1 by my own will and continued to bump my head against the wall in attempt to "please" The Powerful Guy and his cronies. OK. Another lesson learnt.

are you serious? Wearing gloves to draw up propofol? I hope this attending is not the one expecting you to do that.

Circulators running around trying to find an unsigned syringe? What??

What the hell kinda place is this and who are these attendings who are placing these unreasonable demands on a resident?

This "powerful guy" needs a lesson in humility. I think you should become a member of the ACGME residency review committee and then show up at his program and given him a taste of his own medicine.

 

[toughlife]

duplicate

 

[michgirl]

.

 

[coprolalia]

That was EXACTLY what I did.

Did you...

(1) Document your concerns in email?
(2) Save those emails and their responses?

When you started seeing the writing on the wall, you needed to go into full court press defensive mode.

-copro

 

[michgirl]

Did you...

(1) Document your concerns in email?
(2) Save those emails and their responses?

When you started seeing the writing on the wall, you needed to go into full court press defensive mode.

-copro

If you're a fly and found yourself in a spider can, whom should you ask for instructions?

Should I address emails promptly to the same people who just did all of this? Or to people who know all of this very well but perfectly happy with it? Both groups prefer to see residents helpless, terrified and with heads bowed below the floor forever. The third grop, me being honest, does existbut it is small and has no power in the program management.

 

[Hockeyguy]

The Powerful Attenging roaring in front of me that, if next time he sees me refilling propofol without gloves, he will crush my stupid head against the wall.

I don't really know, or care for that matter, about the specifics of your story. IMHO it's hard to get fired and if they canned you its highly likely you are pretty brutal. Mil echoed my feelings his first post on this thread.

That being said if you can find ONE PERSON willing to corroberate that they heard this guy say that to you. Get a lawyer and prepare to collect a large check and see how fast it takes that guy to get fired. Either that or they will hire you back in ten seconds and you will graduate on time. Mention that part of your story to a lawyer and watch them go to town.

 

[coprolalia]

Should I address emails promptly to the same people who just did all of this? Or to people who know all of this very well but perfectly happy with it? Both groups prefer to see residents helpless, terrified and with heads bowed below the floor forever. The third grop, me being honest, does existbut it is small and has no power in the program management.

It's too late now for you, if you didn't do this already. This is a lesson to current/future residents who are getting the screws turned to them.

(1) After you get your first performance evaluation that says you are "inadequate" or "unsatisfactory" or any other derogatory and negative opinion about your work that isn't substantiated by specifics, you email your program director indicating your confusion and ask for those specifics.

(2) If he refuses to return your email but agrees to meet with you to discuss, you take notes. At the end of that meeting, you immediately form and send an email to him recounting the specifics of the meeting including what was exactly said, what the plan of action was, and recounting what he/she told you to do to correct whatever perception. If he/she is unable to give you specifics about your performance, you say that in the email.

(3) You then periodically email your program director before the next review cycle and you tell them that you feel you are progressing well, and that if anyone has any particular concerns that have been expressed to him you'd like to know about them. You then go back to step (2).

(4) Also in the interim, you need to email your program director with instances where attendings - with specifics (place, date, time, patient med record #, etc.) - did something that was either dangerous, demeaning, not standard of care, or personally insulting to you. If you go back to item #2 and are not getting satisfaction, you need to quietly go to Human Resources in the hospital and lodge your complaint.

(5) You should be repeating steps (2) and (3) throughout your residency. You should refuse to sign negative evaluations in your residency folder that have no merit, instead writing a reason unemotionally why you disagree with the evaluation.

This is how you create a record and have the paper trail to lodge a legal complaint against any employer who abuses you. What's most sad, though, is that likely they did have a major problem with your performance but, like most academic centers, were too inept to help you fix it. Most physicians are horrible managers. They are so used to having talent around that conforms with their idea about what should be done that they don't know how to function with what they perceive as a "problem" resident. Other times, it's just an ego war. And, if you can persist and document, you're likely to win. They'll either be too chickensh*t to fire you, or will give you your job back after you have your lawyer call them with a pile of documentation that shows you tried to proactively address their concerns but were met with stonewalling.

-copro

 

[lvspro]

Allow me to reiterate. If someone is dismissed from a residency, then I'm willing to bet it's not exclusively an "attending that hated me." You really gotta fuggit up good to get canned.
Medicine is becoming this "hand-holding" profession where everyone gets a trophy for participating. Maybe I'm being a bit too rough here... lets look at a couple of other specialties where you're not dealing with SOMEONE ELSES LIFE!
Attorney: if you suck in law school yer arse gets canned. Once you're in the real world, and you're lucky enough to get hired, if you suck, you get canned. Ok, well, let's just say you go in to business for yourself as "Harry Feltersnatch LLC, Attorney at law." I got news for ya harry, if you suck, and lose all your cases you may have difficulty finding clients. It sucks, but it's true. It's called reality.
Investment Banker: Same as above.

Now what if you happen to be an attorney/banker, and are really good at what you do, but you're just a raging d!ck that nobody at the group likes. If you make the group a ton of money bc you're really good at what you do, they likely will keep you (grudgingly, but they will because you're an ASSET)

Flashback to medicine. How many of you know that resident in (insert specialty) that whenever you see them work, you think to yourself "oh my god!! how the fug did they make it this far?" Yet still they are allowed to graduate.This is not a goddamn popularity contest! Let's stop treating it that wa!

Anyone on this forum telling this person to pursue a lawsuit is either not very bright, just got done reading a chicken soup for the soul, or completely ignoring the fact that maybe, just maybe it wasn't the evil attending that undid this resident.

I truly do feel for this person, and if there was anything I could do to help, then I would. Unfortunately I can't, but at least I can insert MHO. One thing I can recommend is to talk to any friendly higher-ups at that program to see if they are able to help you land a residency in another specialty. Again, gas ain't for everyone.
Peace

 

[coprolalia]

Lvspro, please, PLEASE, PLEASE never become an educator.

More often than not, a failure of an individual in a program is a failure of the program, not the individual. The program selected that person for a spot. The program was charged with developing that person into a competent clinician. The program is responsible for providing concrete feedback to that person on what they're doing wrong and how they can do better.

I see this bullsh*t all the time. People in charge often make a decision as to whether or not someone's got "the stuff" their first friggin' month of residency. We're not talking about someone who got picked up on a street corner and had a MacIntosh blade and Baby Miller stuck in their hand then told, "Okay, go figure it out on your own." At least we shouldn't be.

If someone is doing poorly in a program, that program has the responsibility to tell them exactly why. I've seen this happen in my program. Someone is labeled as a "problem" very early on, and they can never shake it no matter what brilliant thing(s) they subsequently do. Likewise, I've seen people labeled as superstars do some of the most ******ed **** on the planet. In the case of someone labeled a troublemaker, any subsequent stellar performance is often either overlooked or labeled as "lucky." With the person perceived as the superstar, their failures are dismissed as "having a bad day" or the like.

Programs - all employers - owe it to their charges to quantify their failings and help them remediate them. Your comments actually prove the point I've been making all along. This chick was strung along for three years before her program dumped her. That's reprehensible in my not-so-humble opinion. And, sadly, many times without the threat of legal action people who have the power are resistant to change their bad habits.

Trust me. I keep a detailed list of the hare-brained stuff I see some of my attendings do. Call me paranoid if you want. I call it insurance.

-copro

 

[aredoubleyou]

Lvspro, please, PLEASE, PLEASE never become an educator.

More often than not, a failure of an individual in a program is a failure of the program, not the individual. The program selected that person for a spot. The program was charged with developing that person into a competent clinician. The program is responsible for providing concrete feedback to that person on what they're doing wrong and how they can do better.

-copro

Very True, at least in most cases. Residency programs are choosing not from the general population, but people who have successfully navigated life and put in the effort to excell in college, pass (likely scoring well for anesthesia) med school, all while typically making significant sacrifices along the way. Very few people in this group are either too lazy or too incompetent to improve upon their deficiencies.

 

[coprolalia]

Anyone on this forum telling this person to pursue a lawsuit is either not very bright, just got done reading a chicken soup for the soul, or completely ignoring the fact that maybe, just maybe it wasn't the evil attending that undid this resident.

Lvspro, please re-read the following from my post...

What's most sad, though, is that likely they did have a major problem with your performance but, like most academic centers, were too inept to help you fix it.

Ones with power shouldn't be allowed to punish someone else for their own mismanagement. That becomes a system, quite simply, of demagoguery. We are all supposed to be professionals. Aren't we?

I know a lot of these so-called "leaders" who are long on theory and short on effective implementation when it comes to improving someone's performance. Especially in the world of medicine where there are often several right answers in any given situation, it can become quite arbitrary when meting out performance appraisals.

The lazy approach, one that I've personally seen supervene, is to default to an evaluation of that person's personality. If someone is seen as a PITA (pain in the ass), people will tend to pick solely on what they do wrong, not right. Likewise, a spineless yes-man will often get a better appraisal despite the fact that they may be a horrible clinician.

I'm not saying that "likeability" shouldn't be a factor. It just shouldn't be the only factor. Often, in residency evaluations, it is.

-copro

 

[dfk]

More often than not, a failure of an individual in a program is a failure of the program, not the individual. The program selected that person for a spot. The program was charged with developing that person into a competent clinician. The program is responsible for providing concrete feedback to that person on what they're doing wrong and how they can do better.


If someone is doing poorly in a program, that program has the responsibility to tell them exactly why. I've seen this happen in my program. Someone is labeled as a "problem" very early on, and they can never shake it no matter what brilliant thing(s) they subsequently do. Likewise, I've seen people labeled as superstars do some of the most ******ed **** on the planet. In the case of someone labeled a troublemaker, any subsequent stellar performance is often either overlooked or labeled as "lucky." With the person perceived as the superstar, their failures are dismissed as "having a bad day" or the like.

Programs - all employers - owe it to their charges to quantify their failings and help them remediate them. Your comments actually prove the point I've been making all along. This chick was strung along for three years before her program dumped her. That's reprehensible in my not-so-humble opinion. And, sadly, many times without the threat of legal action people who have the power are resistant to change their bad habits.

-copro

assuming this occurred, don't you think that 3 years of attempting to remedy the 'problem(s)' of this resident, that the program tried to "make it better", was more than adequate time?

to me, it seems the program did their part, but the resident was just not up-to-snuff. and maybe said resident didn't "hear" what the program was alluding to for fixing the concerns, but just heard what they wanted to.
not an impossibility here.

again, as previously stated,
anesthesia isn't for everyone

 

[pgg]

This chick was strung along for three years before her program dumped her.

From afar, I have a great deal of difficulty telling the difference between

• a bunch of corrupt cynics and inept teachers stringing someone along for 3 years to extract cheap labor, with no intention of ever allowing that person to graduate
• a bunch of compassionate dedicated educators, giving multiple "second" chances, working hard to help a poor resident make it through, generously not firing that resident after one or two marginal years, because they saw hope and potential ... finally deciding that the resident must not graduate for the good of the resident, the profession, future patients, and the hospital's risk management department

We have one side of the story here.

I disagree with the notion that completing medical school implies a baseline level of competence and aptitude that is good enough for successful completion of an anesthesiology residency, if only the program teaches well enough. Even completion of residency doesn't guarantee competence - some graduates will be unable to pass their written or oral boards.

There really are only two options for dismissing a resident for academic/clinical reasons. Fire them early, or fire them late after attempts to remediate them. This person was fired late, and despite lots of text over a couple pages in this thread, we really don't know why. If she had been fired early, you could make the same argument that the program failed her and didn't give her a fair chance.

 

[KNC]

From afar, I have a great deal of difficulty telling the difference between

• a bunch of corrupt cynics and inept teachers stringing someone along for 3 years to extract cheap labor, with no intention of ever allowing that person to graduate
• a bunch of compassionate dedicated educators, giving multiple "second" chances, working hard to help a poor resident make it through, generously not firing that resident after one or two marginal years, because they saw hope and potential ... finally deciding that the resident must not graduate for the good of the resident, the profession, future patients, and the hospital's risk management department

We have one side of the story here.

I disagree with the notion that completing medical school implies a baseline level of competence and aptitude that is good enough for successful completion of an anesthesiology residency, if only the program teaches well enough. Even completion of residency doesn't guarantee competence - some graduates will be unable to pass their written or oral boards.

There really are only two options for dismissing a resident for academic/clinical reasons. Fire them early, or fire them late after attempts to remediate them. This person was fired late, and despite lots of text over a couple pages in this thread, we really don't know why. If she had been fired early, you could make the same argument that the program failed her and didn't give her a fair chance.

I agree.......

 

[lvspro]

Lvspro, please, PLEASE, PLEASE never become an educator.

I actually have been commended on teaching skills by our PD just before leaving to an off-site rotation. I'm patient, I explain things as clearly as possible, I set concrete expectations of my juniors, and provide immediate feedback. Everything from techniques of popping in an a-line to how to chart properly is touched on when I have a junior. I'd be happy to ask a few of them to post if you have any trouble believing me.

More often than not, a failure of an individual in a program is a failure of the program, not the individual. The program selected that person for a spot. The program was charged with developing that person into a competent clinician.

This assumes the person has the ability to develop into a competent clinician IN THIS FIELD. Unfortunately not everyone is suited to a career in gas.

The program is responsible for providing concrete feedback to that person on what they're doing wrong and how they can do better.

Agreed. Concrete examples on improving performance is a good thing.

I see this bullsh*t all the time. People in charge often make a decision as to whether or not someone's got "the stuff" their first friggin' month of residency. We're not talking about someone who got picked up on a street corner and had a MacIntosh blade and Baby Miller stuck in their hand then told, "Okay, go figure it out on your own." At least we shouldn't be.

If someone is doing poorly in a program, that program has the responsibility to tell them exactly why. I've seen this happen in my program. Someone is labeled as a "problem" very early on, and they can never shake it no matter what brilliant thing(s) they subsequently do. Likewise, I've seen people labeled as superstars do some of the most ******ed **** on the planet. In the case of someone labeled a troublemaker, any subsequent stellar performance is often either overlooked or labeled as "lucky." With the person perceived as the superstar, their failures are dismissed as "having a bad day" or the like.

Another point of agreement, despite how unfair it may be.

Programs - all employers - owe it to their charges to quantify their failings and help them remediate them. Your comments actually prove the point I've been making all along. This chick was strung along for three years before her program dumped her. That's reprehensible in my not-so-humble opinion. And, sadly, many times without the threat of legal action people who have the power are resistant to change their bad habits.

Trust me. I keep a detailed list of the hare-brained stuff I see some of my attendings do. Call me paranoid if you want. I call it insurance.

-copro

As someone else mentions, whether she was strung along for cheap labor, or kept for the purpose of trying to remediate them is unclear. I'm playing devils advocate here and looking at it from the other side.

 

[Gern Blansten]

I disagree with the notion that completing medical school implies a baseline level of competence and aptitude that is good enough for successful completion of an anesthesiology residency, if only the program teaches well enough. Even completion of residency doesn't guarantee competence - some graduates will be unable to pass their written or oral boards.

I agree. Once you are "in the system" of medical school, it is almost always completed...maybe a year late for remediation, but almost all who start finish. Does the fact that they had the book smarts to pass a few tests imply that they will naturally all be excellent clinicians who will, without any doubt, choose the correct field of medicine and complete a residency satisfactorily? If it does, why bother with evaluations? Just make it a feel good experience and give everyone participation trophies.

I do not disagree that there are some malignant, self serving faculty out there who will do as Copro suggests. I know they exist. I have seen them and heard of others who have experienced them. But on the other hand, I have also seen some scary people who had clearly made a horrible career choice and DO NOT have the ability to "get better" and become a competent anesthesiologist. Copro, are you suggesting that a program should ignore the instinct of the academic faculty and just let it slide and allow the resident to finish the program?

As stated prior, there are always two sides to the story and the truth is usually somewhere in between. It seems that many people are taking the stance that it is an inherent right that if you begin a residency, you will finish it, no matter your level of ability; and if it does not occur, it is wholely a failure of the residency program and faculty. I think most here recognize that some extremely smart people who start an anesthesiology residency are not cut out to do what is required, and thus struggle. Many times, that can be overcome with some special attention given to that resident. In some (thankfully rare) instances, I don't think it is possible.

A residency program has a one day interview with the applicant before having to make a decision on whether they will be successful over the next four years in completing the residency program. Most of the time, they get it right. It is rare that a resident gets released from a program(ie, it takes quite a bit of messing up to cause it to occur).

My point is, let's not condemn every member of academic medicine based on this incident for which we have only a few details. We certainly should not condemn lvspro for stating his feelings on the matter. I suspect he would be an excellent and caring teacher based on his behavior here on this message board.

 

[coprolalia]

Copro, are you suggesting that a program should ignore the instinct of the academic faculty and just let it slide and allow the resident to finish the program?

...

It seems that many people are taking the stance that it is an inherent right that if you begin a residency, you will finish it, no matter your level of ability; and if it does not occur, it is wholely a failure of the residency program and faculty.

Gern,

With all due respect, I think you've missed the point. Please re-read my posts, including the above where I clearly state that this program indeed probably recognized a serious problem with this individual - whatever that problem may have been. Then, after you've read what I'm about to write below, see if you can understand my where I'm coming from based on my forthcoming clarification.

It is all about appropriately articulating the exact nature of the problem with the resident. You cannot and should not legally be able pass off opinion and innuendo, without facts, as "employee development" - even if those comments are generally good. You have to specifically tell people what they are doing wrong, as well as what they are doing right.

Trust me, I know this firsthand. In a job I had before I went to med school, we had to fire an individual. In order to do this, we were required to take several months to amass specific instances of this individual's deficiencies from things as trivial as showing up to work late to more serious things such as failing to meet agreed-upon deadlines for important company projects.

Why should residency be any different?

When you start residency, you start with a series of expectations. Paramount among those expectations is safe, timely, and effective patient care under supervision. The key word there is supervision. The ultimate goal of residency is to produce an independent practitioner capable of delivering an anesthetic meeting those criteria. I sincerely hope no one expects that, walking in on day 1, someone will be capable of doing this. Yet, too often such judgments about an individual begin to be made that quickly.

What a program is required to do is ensure that the resident gets sufficient exposure to develop an adequate caseload to provide them that experience, under direction. If that person fails to meet the necessary criteria to do that (e.g. consistently does unsafe things, cannot master basic manual skills within an adequate period of time, makes poor clinical decisions, demonstrates repeated failure to properly develop after remediation, etc.), then these things should be documented specifically with the individual.

For example, a review should include language such as....

"On May XX, 20XX while working with Dr. XXXXXX, you were instructed to give attention to the patient's underlying diagnosis of XXXXXX. The implementation of your plan failed to consider the potential complication of XXXXXX, and had you continued with your plan you would've placed the patient at risk of developing XXXXXXX. In discussing this with Dr. XXXXXX, you demonstrated that you were unaware of this potential complication. You should re-review the peri-operative complications of this condition, and ensure that your practice in the future considers this important aspect of care."

In such an evaluation, you have covered all the necessary items to ensure that the resident is aware of exactly what he/she did wrong, you have given them a plan to correct that inadequacy, and you have notified them that they should not do it again.

Instead, all the resident often gets is (if even this much)...

"In several instances during the past six months, you did not consistently demonstrate safe anesthesia practices."

Now, I ask you, how in the hell does that help someone become a better clinician? Often the person giving the feedback on the evaluation has no earthly idea what the specifics surrounding the generation of such a comment in the first place. How can a program justify (legally) terminating someone based on such an evaluation?

Even worse, some evalutions read like this...

"Resident works hard and always consistently demonstrates excellence."

Or...

"The resident has shown a degree of arrogance and often wants to argue with certain attendings."

Or...

"Some have noticed a severe change in resident's performance not consistent with previous expectations."

How do any of these help someone pinpoint what they are doing right or wrong, reinforce the good things without creating an cocky resident, and provide a path on which to correct deficiencies? I'll give you a hint: they don't.

I don't even read my individual evaluations anymore. I've found that most attendings only fill them out when they are either really pissed off at me or really happy with something I've done. Either way and with rare exception, none of them contain any specific information that helps me. In general, they are a joke. It's just an exercise in frustration for me. Every one of my overall periodic evaluations has been "satisfactory" or "satisfactory with commendation" since starting residency.

But, me? I've given up on this process. I've learned that most residency programs are personality cults - I saw this all throughout medical school without realizing it, and now I see it even more clearly in not only my program but the other residency programs in my institution. And, the fact is, once you've proven (right or wrong) that you're a misfit - which is usually based on your personality - people tend to shun you, and they also start to try to figure out how they can get rid of you.

And, that may be fine and dandy, especially if you're a weirdo or are really clueless. But, I've become far too cynical to believe anything other than the fact that if you fit in and are attractive and people like you, they will generally let a lot of serious performance issues slide. OTOH, if you are unlikeable, people will go out of their way to destroy you rather than help you.

It's human nature. Doctors aren't above it. And, if a program can't quantify those disgressions and inadequacies and attempt to remediate them, they owe it to the person to give them the benefit of the doubt... or at least a pass. Their laziness shouldn't result in the dismissive and carefree destruction of someone's career.

-copro

 

[Gern Blansten]

Copro,
I agree with your points. Thanks for the clarification. I agree that those residents who are struggling need more helpful feedback that can help them to succeed. I also agree with your points about human nature playing a role in a lot of the processes. It is definitely not perfect.

 

[KNC]

I think some of this has to be placed on the resident as far as picking anesthesia as her specialty to begin with....I believe many students pick a specialty based on how much money they will get when they are done...not all, but some; and also how much more time they will have to put into their schooling.....I honestly do not believe that all students take into account their own personality traits when making a residency decision. Not everything comes easy to everyone, but if you are cut out to do something whether it is anesthesia or not, it will start to become second nature. Now if you are struggling (and for long periods of time), then that should send the light bulb off 🙂idea🙂! Maybe I should be looking in a different direction.
For example: If you can't fix things around the house and work with your hands, then don't become a surgeon......(sarcasm)
If you dont like kids, dont become a pediatritian
If you dont like looking into microscopes all day, don't become a pathologist....
If you don't like carpentry, dont become an orthopedic doc....... i can go on and on.....but I think you get my drift......( at any point you can exchange "don't like" with "not good at" wherever you see fit)

 

[persia]

I changed my mind, nevermind. Interesting comments.

 

[CambieMD]

I feel sorry for the op. I suggested that she/he take some time off. Moonlighting may be a good idea. Think about what happened and why it happened. If youhaveno insight as to why things went so poorly it can happen again. When we lack insight life just seems to happen to us. We must be proactive. I knew a guy who was dismissed from a surgery program. I was not at all surprised, he was. You have to read people and their response to you. Often what a colleague says is not as important as what they did not say. When I want to get a feel for what a surgical team is like I say,"antibiotics are in,sir." If the surgeon views me as an important part of the team he will usually say ,"thank you." The arrogent or poorly bred will remain silent or grunt. That simple act gives me loads of information.

If at the end of the day my attending told me good job, I thought nice. If he/she said nothing I would replay my day and think about things that I could have done better. I realize that the Lord Himself could not please some people, also.

My point is that we are responsible to ourselves to make sure that we understand our educational and professional needs and seek to satisfy them.

Trying to sue a residency program would most definately help the lawyers involved.

Cambie

 

[amyl]

my med school class experienced a similar debate....at what point is it the doctor/med students fault vs. the med school/residency program. a med student at my school had a learning disability. i guess it is secondary to a head injury playing football, thats the gossip anyways. this individual is not stupid but speaks in a way that some might interpret as less intelligent. this person made it through the first two years of medical school -- not horrible, not great grades. third year he was dismissed from two hospitals by "mean" attendings, one surgery, one medicine. i don't know who was right or wrong in this situation, just merely that the attendings do have reps for being tough and i can imagine they feel that not everyone can or should be doctors. i don't know what he did to be dismissed. he didn't match and struggled in the scramble. eventually he found an intern year that would take him. problem is, he has yet to pass the PE, failing twice, once for humanistic reasons, second time for data gathering. whatever for that test. my school refuses to help him now at all. another med school helped him with a review course for the PE...he is waiting to hear the results of his third attempt. if he doesn't make it he will likely give up on medicine....with tons of debt.
now this person is not lazy and has put his best effort forth. i am not sure if he is cut out to be a doctor or not. my point is that my school took his $120,000 and let him put himself in debt $200,000 when his fitness to be a doctor has certainly always been in question. i don't really know enough of the facts to make a decision either way but many of my class mates feel like my school has really done him a disservice.

 

[dhb]

now this person is not lazy and has put his best effort forth. i am not sure if he is cut out to be a doctor or not. my point is that my school took his $120,000 and let him put himself in debt $200,000 when his fitness to be a doctor has certainly always been in question. i don't really know enough of the facts to make a decision either way but many of my class mates feel like my school has really done him a disservice.

A lot of people will do you a disservice for 120k. 👎 ... but
before you get yourself into 200k of debt you should be asking yourself if it's the right thing...

 

[CambieMD]

A lot of people will do you a disservice for 120k. 👎 ... but
before you get yourself into 200k of debt you should be asking yourself if it's the right thing...

I agree.

Cambie

 

[dragonfly99]

That story (about the med student) is sad. You can say the person should have had enough insight not to go to medical school, but really some people are quite young when they make that decision, and the tuition is SO high now, that once folks are a couple of years in, it seems quite illogical to drop out. What other job are they going to get w/an undergrad degree and 2 years of medical school that will help them pay back an 80 or 90k debt?
It seems like the medical schools should be able to tell from an application (numbers, MCAT, GPA) whether someone can do the work.

Residency = a slightly different issue, but I tend to think residents getting dismissed often has more to do with someone taking a dislike to the resident than the competence vs. incompetence of the resident. The person picked to be one of the chief residents out of my residency class wrote less than brilliant notes in the chart, didn't seem that smart in morning report, and would give powerpoint talks where things were misspelled and would mispronounce words during grand rounds when he was presenting...would think it would have embarrassed our department chair and PD but apparently they thought that person was the best person for the job. Go figure.

I do agree that personality conflicts likely played a large role in this person's dismissal and she/he needs to figure out how to be more of a smooth operator wherever he/she ends up going. Also, perhaps anesthesiology really isn't the right field for this person...but if so then I think they should have offered her a transfer into medicine or peds or path. or neuro @same institution if she/he is smart enough (it seems she/he is and has passed all the required exams). I think the residency system is not really set up to do education well. It's set up to help hospitals run, and whatever education happens is kind of all secondary to that...I was at a nice academic hospital for my residency, and I shudder to think what it's like at a rough and tumble, economically challenged hospital.

 

[Southpaw]

you should be asking yourself if it's the right thing...

I'm not quite sure what you mean by this. Could you elaborate? In amyl's scenario, and in every one like it, surely the school knows better than the student whether or not they can handle the rigors of medical school. Every student applying thinks they can handle it, or else they wouldn't apply. Truth is, they generally have absolutely NO CLUE what they're headed for and whether or not they're cut out for this job. When I applied I had no clue about Step 1, 2, or 3, or the cost and toughness of each. I had no clue how many poor personalities I'd have to grit my teeth through and swallow my pride while others took power trips on me during the clinical years. And I'm not even in residency yet!

The school should know this stuff, and they have a responsibility to evaluate whether or not a student can cut it. If they decide they can, they have a responsibility to support the student through, provided the student holds up their end of the bargain. It's a symbiotic relationship, especially with the private schools, you pay them a crapload of cash taking on great debt, and in turn they supply you with a MD.

 

[Gern Blansten]

you pay them a crapload of cash taking on great debt, and in turn they supply you with a MD.

Is that how it works? Seriously? What you describe seems more like an online diploma mill.

Should medical schools/residencies be in the diploma mill business? If so, why not do some online courses through University of Phoenix and take out any of the pretenses?

 

[EM_Rebuilder]

Did it more than once in ICU, being all alone. Enjoyed it and did it all right.

And for 2 years I pleaded EVERY SINGLE attending there - please, give me details, please explain. Nothing, ever. Instead, nurses searched my room for unsigned syringes, so I could be castigated one time more for another "violation" and "lack attention to details".

The thing is: I did the same CA2-level of cases OK in one hospital (where attendings sit in the room and teach and still give residents some freedom) and - apparently - not OK in another one (where I was yelled at for everything). Both have typical patient ASA3 or 4.

Actually, I had LESS mistakes than many of my classmates b/o I was so careful and concentrated. Is being careful and detail-oriented bad for doing anesthesia?

Anyway, I've got it. Maybe switch of specialities would work just fine. And I will not have to explain again and again how and where I lost my self-confidence.

I think baby sitting patient in the ICU versus managing 4 sick patients in the ER is VERY different.

I am still immature in my training, but I was the man many time in overnight call in a few different ICUs my intern year.... usually 20+ patients. The difference is that they are all are tucked in, and occsaionally one may go south or a new patient comes in... but seldom much more would be going on at the same time.

In the ER you may have 3-4 brand new critically ill/trauma patients that you are trying to figure out what the heck is up, PLUS keep the sprained ankles moving and the family with AMS momma thats mad because you haven't popped your head in the last 30 minutes... and the nurse is ready for the pelvic in wherever. Oh, and EMS needs some medical direction, and Doctor Jeebers from Podunkville is on the line for a transfer call. VERY different from an ICU.....

 

[amyl]

i personally had no idea what medical school really meant when I signed up for it.

 

[dhb]

i personally had no idea what medical school really meant when I signed up for it.

If you have enough money that is doesn't matter fine if not then it's plain stupid.

 

[Southpaw]

Is that how it works? Seriously? What you describe seems more like an online diploma mill.

Should medical schools/residencies be in the diploma mill business? If so, why not do some online courses through University of Phoenix and take out any of the pretenses?

Should they? No! Are they? Yes! Look at how many DO schools have popped up in the past decade. Look at how many grabs the Carib pumps out every year. What is it...they have like 3 or 4 different classes start a year now? I can assure you that these places are more in the money making business than they are in the producing quality physicians business. Are they any different than U of Phoenix? I don't know, I've been to neither so I can't compare. I can tell you though that the number of residency spots isn't nearly keeping up with the number of people that will apply for those spots in the next 10 years. Why do you think that is?

 

[QofQuimica]

i personally had no idea what medical school really meant when I signed up for it.

I agree. Actually, I *did* have an idea of what medical school really meant, but it was wrong in so many ways to the point of being naive. I am a researcher; I did *tons* of research on medical schools and spent lots of time with doctors before deciding to embark on this path. But I still didn't really know what it would be like, especially the clinics.

I now understand better why med schools place such a premium on applicants having experience in a health care setting. It's not that you learn much about how to be a doctor, but you do get a chance to hang out around people who are stressed, unhappy with their choice, and telling you all the reasons why you shouldn't do it. You spend a lot of your volunteer time doing jobs that no one wants to do but that need to get done, and you get a feel for whether you can stand being the low man on the totem pole, whether you are willing to take one for the team sometimes. You get a chance to experience being a cog in the machine instead of the bright hotshot who's always being told how great and brilliant you are. If you can still find some good in that and learn something, then you'll probably be ok in med school (assuming you can also manage to pass all of the exams).

 

[Leverage]

i personally had no idea what medical school really meant when I signed up for it.

I think they want it this way... Otherwise you would have to have a screw loose to sign up

 

[dhb]

I agree. Actually, I *did* have an idea of what medical school really meant, but it was wrong in so many ways to the point of being naive.

I'm not saying you should know all the details but before signing out on 12+ years of your life a little information and introspection is warranted

 

[QofQuimica]

I'm not saying you should know all the details but before signing out on 12+ years of your life a little information and introspection is warranted

Oh, I agree. I'm just saying that no matter how well you think you know what you're getting yourself into, you really have very little clue until you are already neck-deep in this s***. 🙂

 

[lvspro]

OMG!! I know this person.
Good luck in your search for something... you truly do have my best wishes.
Please keep us posted on where you end up.

 

[911_turbo]

This sounds like a program I have heard of. Does this program have a reputation of dismissing residents in the past? Or them leaving on their own late in their training?

 

[lvspro]

This sounds like a program I have heard of. Does this program have a reputation of dismissing residents in the past? Or them leaving on their own late in their training?

Hi
I'd like to answer the question, but I don't know where the OP stands on me making any comments about this. If you email her, and she gives me the ok, I will discuss past dismissals. I think I may be crossing boundaries if I discussed this persons issues, so I will leave that for her, and focus only on previous dismissals.

 

[cfdavid]

Read Toughie's post.

Then reread it.

Then read it again.

And realize its DA TRUTH....

as your anger/frustration/resentment builds, take some deep breaths, light a candle, pikka great Cab outta your frig, pour a full pour portion into your glass,

sit back into your favorite, most comfortable chair/couch/bed, turn on your favorite tunes, and read the

BOW YOUR HEAD thread.

It'll contribute to your inner peace.

Cheers.

Jet, is there any way we could sticky the Bow Your Head thread? I really think that it could be useful to have handy for anyone struggling with a tough day or a malignant personality etc.

 

[pseudoknot]

Jet, is there any way we could sticky the Bow Your Head thread? I really think that it could be useful to have handy for anyone struggling with a tough day or a malignant personality etc.

It's not so easy to find, due to the worthless vBulletin search function:

The following words are either very common, too long, or too short and were not included in your search: bow, your

But here it is after searching for "head" in titles only:
http://forums.studentdoctor.net/showthread.php?t=548150

 

[jetproppilot]

Jet, is there any way we could sticky the Bow Your Head thread? I really think that it could be useful to have handy for anyone struggling with a tough day or a malignant personality etc.

You got it, Brother.

I'm gonna stick it the only way I know how....if someone wants it to appear different lemme know and I'll find someone smarter than me to fix it.👍

 

[cfdavid]

You got it, Brother.

I'm gonna stick it the only way I know how....if someone wants it to appear different lemme know and I'll find someone smarter than me to fix it.👍

Thanks man. That'll be a good resource to reflect back on and even add to over time.