Failure to Progress.

[TriedAndTrue]

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Would like some advice on what specifically this means.

Had a recent mid-intern year performance review and this was raised, albeit a small possibility. I know it can be rough on these boards, but I'm just looking for some advice to take in for the new year and for my personal improvement.

A bit about me.
Graduated from an American Medical School, decent (average) board scores, well published, truly committed to an academic career.

IM resident at academic medical center. Feedback from attendings and residents has been appropriate (good stuff and things to work on that are fairly generic), no red flags raised to me personally. Attendance prompt, efficient, within work hours, haven't made a gross or egregious mistake, give decent presentations, report data appropriately to residents/attendings, make good calls regarding level of care. In short, I feel I am a solid resident. Nothing steller, not anyone that is going to lead morning report at this time of year, but a solid, say B+ resident.

How my evaluation was broken down...
1. Interpersonal skills/professionalism, ability to get things done: Excellent
2. Organization/efficiency: similar to peers
3. Ability to improve physician practice from 3mo review: Excellent
4. Clinical Reasoning and Crosscover issues: Needs work. (no concrete specifics were given outside what was written in my evaluations, and no feedback was given in how to improve.)

However re: #4, I've identified this area after the 3mo review and have asked my residents to help me in this area and the past 4 have all said that I'm on track, thinking about things in real time correctly, and to keep it up, etc etc.

I guess, I'm scared about the next few months, that my work is going to be scrutinized to a higher degree, and I don't know how to correct it if the perception is out there among leadership that I'm a "bad resident". I'm not bummed out, things are fine outside the hospital, and I will do whatever it takes to improve, get better, be the best doc that I can for my patients.

I guess, I'd like to some advice on how to proceed. I feel my next ward rotation is one I have to kill to get past this, but I don't know what I can do to help address #4 other then being upfront with my resident about how I can work on this.

Any perspectives and advice are graciously and humbly appreciated in advance

Thank you.
TT

 

[bigDinLV]

You're a first year resident. Compare to other first year residents and see if they got the same. After 6 months you're going to still need improvement in plenty of areas when compared to a senior resident or similar situation.

We have to do peer evaluations and I pretty much just give the senior residents all "outstanding" and then each year down gets one level less. Pretty generic, but fair and easy I guess.

 

[gutonc]

It doesn't sound like they've really given you enough information to go on here (or at least you haven't provided it to us), so it's really hard to give you much useful advice.

What you absolutely must do from here on out though is clear. Document, document, document. Ask for (and be sure you get) written feedback from your resident and attending at least twice a month for the remainder of your rotations. Document your responses to critiques and what you agree to do to fix any problems. Document any complaints you get from (or have about) allied health providers.

Make copies of all of this for yourself and send copies to the PC and your GME office.

 

[shopsteward]

You are doing the right thing in dealing with this issue promptly.

Gutonc is right about documenting everything. You should already have a lot of useful documentation, such as your residency contract, which should make clear how performance issues should be dealt with. (If you know what procedures could be applied, that means you also know what you need to do in order to avoid them being applied to you, and how to ensure that if they are applied, they are applied correctly.)

You identified a potential issue at 3 months but didn't seem to get far with dealing with it, probably because of a lack of specific input from others, eg your residents. Your mid-year review identified the same possible issue, but with a similar lack of detail. The way to make progress now is firstly to work out the specifics of what the issues are.

You may be able to work out the specifics by looking at whatever documentation you have on what you are expected to know/learn as an intern, and combining it with whatever you have been told, in writing and orally, are the potential concerns. Make sure you know the totality of what is expected of you, and then break it down into smaller areas of knowledge/behaviours which you can work on indiividually. Work out which of these individual areas are likely to be the most important/difficult for you to demonstrate achievement in, and how you think you can tackle them. Think about taking this action plan to your assessor to see whether they agree with your analysis and proposed plan of action, and whether they have any other suggestions.

It might be worth creating a document which shows -

1) the clinical reasoning and cross-cover skills and behaviours which an intern needs to demonstrate,
2) what you have learnt/done in these areas, and
3) how you meet the appropriate standard.

This document would mostly be for yourself, but might come in useful if performance issues get raised formally. For instance, the second of the steps is evidence for 3. But it might also be useful in showing direction of travel if 3 is disputed/in doubt. (Showing direction of travel may get you further opportunities to show that you can meet the required standard.)

You seem have the goodwill of your residents. What you don't seem to have is their specific attention on your specific issues. So once you have identified the most pressing issue for action, pick a specific resident, tell them you want to focus on dealing with that issue in that rotation, say what you are proposing to do to improve, and ask them for any further suggestions on what to do. If you tell them that you would like them to be able to say at the end of the rotation whether they think you meet the standard on that issue, it should focus their minds beyond their current generic "fine", without asking them to do too much heavy lifting. (Speaking from that side of things, confirming/remediating individual performance can often feel like heavy lifting, particularly for those who are not individually engaged with the person/issues involved). Rinse and repeat until you have addressed all of the potential areas of concern, and there are people who can confirm that you have done this.

Finally, you say you are scared about the next few months. Don't be. Just concentrate on each rotation as it comes, break it down into shorter periods if appropriate, and engage one or more residents individually in guiding/assessing what you do during that period, with specific reference to specific areas of concern. If you do this, you are demonstrating that you have what it takes to be successful as an intern and resident, and then as a doctor.

If you have a resident adviser, you might think about speaking to them too.

Good luck.