Fired from Residency?

[AdmiralChz]

You’d be surprised how sky-high board scores can really impair critical analysis of an applicant. We had one particularly ridiculous resident who we had to usher out - it was apparent day 1 he was gonna be an issue but his near 280 Step 1 got everyone all starry-eyed. This guy’s solution to hypoxia in the middle of a case was to extubate the person and bag them and not call for help... it scared surgeons so much they refused to work with that individual.

After that and others they started blinding interviewers to scores, which made critical analysis of applicants better IMO. The scores came up during the rank meeting done monthly.

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[deleted592694]

I've found the tip can some times fold over and have to place a finger in the mouth to flip it over. If you have a 100% successful method of placing an LMA without EVER having to place a finger/hand in a patient's mouth, please let me know, because I genuinely would like to know.

Why would you need to put your hand in someone's mouth to place an lma?

 

[Twiggidy]

You’d be surprised how sky-high board scores can really impair critical analysis of an applicant. We had one particularly ridiculous resident who we had to usher out - it was apparent day 1 he was gonna be an issue but his near 280 Step 1 got everyone all starry-eyed. This guy’s solution to hypoxia in the middle of a case was to extubate the person and bag them and not call for help... it scared surgeons so much they refused to work with that individual.

After that and others they started blinding interviewers to scores, which made critical analysis of applicants better IMO. The scores came up during the rank meeting done monthly.

When the CA-1 decides to EXTUBATE because of hypoxia, instead of, I don't know, say 1) placing on 100% 2) making sure it's not mainstemmed 3) calling the attending......

 

[deleted171991]

I've found the tip can some times fold over and have to place a finger in the mouth to flip it over. If you have a 100% successful method of placing an LMA without EVER having to place a finger/hand in a patient's mouth, please let me know, because I genuinely would like to know.

That reminds me of certain CRNAs who always place LMAs with a tongue depressor.

Btw, the solution to your problem is called i-gel.

 

[deleted592694]

I'm genuinely asking for tips coming from someone in residency and not for sarcastic remarks; we have iGels and LMA Supremes as well as the Classic at my humble institution; do you extend the head and open the mouth by pressing down on the chin? I've found ways to facilitate LMA placement but some involve an element of scissoring the mouth or pushing the tongue out of the way. What is a 100% successful way of placing an LMA without EVER placing a finger/hand into a patient's mouth?

That reminds me of certain CRNAs who always place LMAs with a tongue depressor.

Btw, the solution to your problem is called i-gel.

 

[PainDrain]

I have known or heard of several people being politely told they needed to look toward another career but only two were actually fired. One was an IM resident who had matched into GI and was only months away from finishing. He apparently had sticky fingers and was stealing from everyone; nurses, fellow residents, ect. He was eventually caught because he stole someone’s credit card and used it. . *****. The other instance I know of someone being fired was due to substance abuse; person was injecting propofol and it was suspected they were abusing other substances as well.

Two strange instances that occurred during my anesthesia training involved surgical residents quitting. Both involved ortho. One guy was an intern and simply stopped showing up. Two weeks went by and he simply called and said he quit. No explanation and no clear plan what he was going to do next. The second guy entered ortho after leaving another surgical subspecialty. He last something like 3 months before asking for a latter of recommendation to jump ship to another field.

 

[deleted171991]

I'm genuinely asking for tips coming from someone in residency and not for sarcastic remarks; we have iGels and LMA Supremes as well as the Classic at my humble institution; do you extend the head and open the mouth by pressing down on the chin? I've found ways to facilitate LMA placement but some involve an element of scissoring the mouth or pushing the tongue out of the way. What is a 100% successful way of placing an LMA without EVER placing a finger/hand into a patient's mouth?

Sorry if it sounded like sarcasm.

The igel is the only LMA where I can just press down on the chin and place the LMA. I rarely if ever have to put my fingers inside the patient's mouth. The key is to be gentle and not try to force a huge LMA into a small throat. Also, once at the level of the tongue (which can be a bit of challenge for the beginner), I do a couple of to-and-fro motions, to release the tongue and find the right spot. I also lube the back of all my LMAs.

Don't feel bad if it takes a while to get it. I have inserted more than 1,000 LMAs.

 

[Psai]

Yep I also lube the rear tip for insertion

If you have to I guess you can use a tongue blade or even a laryngoscope for placement but igels slide in pretty easily for the most part. The toughest part is keeping the tongue from sticking to it. I have only placed about 100 lmas in my career.

 

[deleted162650]

Yep I also lube the rear tip for insertion

Anyone else wanna take this one? Anyone??

 

[narcusprince]

I’m my program we ****canned between 1 and 2 residents during orientation seemingly every year. I never disagreed with it, they were always unsafe and a very bad fit for acute care. One of them I remember was told she had to stop holding the laryngoscope with two hands and then dropped it on the patient’s teeth from height. Another wouldn’t place LMAs because she couldn’t mentally put her hands in someone’s mouth.

So let me get this right she could hold a laryngoscope with two hands? Does she have a sister? Honestly those things can be worked on. The two handed lady. If your not comfortable putting things in peoples mouth you should not be in anesthesia(I was always very good at putting things). Integrity is everything in our field. I can fix everything else integrity I cannot.

 

[deleted171991]

If your not comfortable putting things in peoples mouth you should not be in anesthesia(I was always very good at putting things).

QFP.

 

[MirrorTodd]

You’d be surprised how sky-high board scores can really impair critical analysis of an applicant. We had one particularly ridiculous resident who we had to usher out - it was apparent day 1 he was gonna be an issue but his near 280 Step 1 got everyone all starry-eyed. This guy’s solution to hypoxia in the middle of a case was to extubate the person and bag them and not call for help... it scared surgeons so much they refused to work with that individual.

After that and others they started blinding interviewers to scores, which made critical analysis of applicants better IMO. The scores came up during the rank meeting done monthly.

When the CA-1 decides to EXTUBATE because of hypoxia, instead of, I don't know, say 1) placing on 100% 2) making sure it's not mainstemmed 3) calling the attending......

View attachment 235036

While explaining to the patient what he did...

 

[acidbase1]

huh?? did you actually read the story or am I reading your post wrong? the dude got fired for NOT moonlighting but still handing in payment forms to the office. douche move on his part, I mean WTF. and the 2nd story, good lord, what kinda lazy ass people are med schools allowing in these days; i'm surprised he was able to work hard enough to match into radiology but then decides to take a vacation?? doesn't make sense, again WTF. btw, where did he actually get signatures from - did he just forge them??

the only person I know of who got fired while I was in residency was a year ahead of me and partaking of a little ketafol while on call. good thing no patients were harmed.

Yes clearly misread. I thought he was just working outside of residency and got busted. Definitely would’ve fired his a$$

 

[anbuitachi]

You’d be surprised how sky-high board scores can really impair critical analysis of an applicant. We had one particularly ridiculous resident who we had to usher out - it was apparent day 1 he was gonna be an issue but his near 280 Step 1 got everyone all starry-eyed. This guy’s solution to hypoxia in the middle of a case was to extubate the person and bag them and not call for help... it scared surgeons so much they refused to work with that individual.

After that and others they started blinding interviewers to scores, which made critical analysis of applicants better IMO. The scores came up during the rank meeting done monthly.

Maybe this resident was so smart he immediately knew the problem was the tube and therefore extubated the patient. though how long did this guy bag the patient for.. until the end of the case?

 

[MirrorTodd]

Yes clearly misread. I thought he was just working outside of residency and got busted. Definitely would’ve fired his a$$

We'll get fired for moonlighting in the Army.

(We shouldn't actually NEED to moonlight during residency though.)

 

[BobLoblaw78]

This seems highly subjective. Especially if the attending obgyn knew said resident did the physical exam. I could see the conversation being the patient has xyz patholgy check it out. As an attending physician I had a colorectal surgeon ask me to palpate a rectal cancer. Colorectal cancer runs in my family so with the attending guidance I felt the mass. Never did I feel like it crossed the line.

If you don't cross the white line then it was probably not a thorough enough exam to punished! lol

 

[skypilot]

I remember this kind of discussion about somebody in my program. The logic was simple: if it's a serious character flaw or a bad personality fit, it cannot be fixed and the sooner the resident is let go the better. If it's a knowledge issue, then there is still a chance.

To be honest, I don't think people should be kept around if there is serious lack of medical knowledge either. The person went on to fail her boards (as predicted), now she's a board-certified attending. She was one of the cases that proved to me that one doesn't need much medical knowledge to practice anesthesia.

I hope you are not holding the initial board failure against this person. Plenty of people are practicing without Board Certification. Plenty of people pass that horrendous multiple choice exam on the second attempt. She has proven she has the knowledge by passing. Now the only thing you can hold against her are the integrity issues. We shouldn't be discriminating against people who have completed 4 years of residency based on a multiple choice exam.

 

[Twiggidy]

I hope you are not holding the initial board failure against this person. Plenty of people are practicing without Board Certification. Plenty of people pass that horrendous multiple choice exam on the second attempt. She has proven she has the knowledge by passing. Now the only thing you can hold against her are the integrity issues. We shouldn't be discriminating against people who have completed 4 years of residency based on a multiple choice exam.

Agree. All I care about is A) Did you pass? B) Are you going to kill anyone? I don't care how good you are at multiple choice tests. Orals could be a better indicator than writtens

 

[nimbus]

I hope you are not holding the initial board failure against this person. Plenty of people are practicing without Board Certification. Plenty of people pass that horrendous multiple choice exam on the second attempt. She has proven she has the knowledge by passing. Now the only thing you can hold against her are the integrity issues. We shouldn't be discriminating against people who have completed 4 years of residency based on a multiple choice exam.

Disagree. Many if not most people pass the written without much effort, many as CA2s. To fail them means you have some serious deficits. Isn’t the first time pass rate in the high 90s?

 

[Twiggidy]

Disagree. Many if not most people pass the written without much effort, many as CA2s. To fail them means you have some serious deficits. Isn’t the first time pass rate in the high 90s?

When you put it that way with regard to writtens I think I change my stance and agree. I think I got confused with orals.

 

[pgg]

I certainly wouldn't hold an oral board failure against someone, assuming they eventually passed. That test is inherently subjective and weird. English as a second language, an accent, an examiner's conscious or subconscious bias ... I've known a more than one excellent clinician who's failed that.

The written is a different sort of animal.

 

[chocomorsel]

I am so confused. If he was part of the team, what is the problem? Was this his patient?

There was an urban legend at my training program about a guy who got fired. He was doing a gyn case and the rotating Ob/gyn med students formed a line between the asleep patient’s legs, taking turns doing pelvic exams. Said resident decides to be cute and get in line. He performs the exam along with the other med students and gets caught. He was then fired from the program.

so

 

[ZzzPlz]

I am so confused. If he was part of the team, what is the problem? Was this his patient?

so

I think that in general, fingering a patient when you’re supposed to be giving an anesthetic is frowned upon

The story was that he just took the liberty himself—he was not invited to do the exam by the gyn team, which would have been a totally different situation obviously

 

[deleted162650]

I think that in general, fingering a patient when you’re supposed to be giving an anesthetic is frowned upon

Wait, what?

 

[nimbus]

I think that in general, fingering a patient when you’re supposed to be giving an anesthetic is frowned upon

The story was that he just took the liberty himself—he was not invited to do the exam by the gyn team, which would have been a totally different situation obviously

As an anesthesia resident, I wouldn’t do a pelvic exam even if I was “invited”. Wtf is wrong with people? In fact, unless they are going into surgery, OB/gyn, or primary care, there’s no reason a med student needs to do a pelvic on an anesthetized patient. And that should be with their explicit consent.

 

[skypilot]

Disagree. Many if not most people pass the written without much effort, many as CA2s. To fail them means you have some serious deficits. Isn’t the first time pass rate in the high 90s?

People take the written as CA2s? Never heard of that. I thought most people waited till after they completed residency to take the boards. Back in the day, people didn't worry about the boards, they would wait for a year after graduating residency to take them.

 

[nimbus]

People take the written as CA2s? Never heard of that. I thought most people waited till after they completed residency to take the boards. Back in the day, people didn't worry about the boards, they would wait for a year after graduating residency to take them.

Maybe things have changed but back in the day we took ITEs which were the same as written boards every July.

 

[San Marzano]

People take the written as CA2s? Never heard of that. I thought most people waited till after they completed residency to take the boards. Back in the day, people didn't worry about the boards, they would wait for a year after graduating residency to take them.

Times are changing. Written boards is now a two part exam, first part is taken at the end of CA1 and second part is taken after graduation. This started like 3-4 years ago I think.

 

[pgg]

As an anesthesia resident, I wouldn’t do a pelvic exam even if I was “invited”.

Not doing pelvic and rectal exams is a perk of this field. 15 years and counting since I've done one.

 

[Twiggidy]

I think that in general, fingering a patient when you’re supposed to be giving an anesthetic is frowned upon

waiting for this thread to derail like......

 

[chocomorsel]

I think that in general, fingering a patient when you’re supposed to be giving an anesthetic is frowned upon

The story was that he just took the liberty himself—he was not invited to do the exam by the gyn team, which would have been a totally different situation obviously

Oh, I thought he was a gyn resident. You didn’t specify. Stupid auto correct. Did not mean “fun”.

 

[chocomorsel]

Douche move to fire someone for moonlighting so long as it didn’t effect their performance/attendance as a resident. We all have/had a mountain of debt

You didn’t pay attention to the details of the post.

 

[ZzzPlz]

Oh, I thought he was a fun resident. You didn’t specify.

Oh he was a fun resident alright (yeah think about that emoji for a second)

 

[chocomorsel]

Who are you to say no? You're an anesthesiologist who should have pride in the field. Plain and simple, it's a risk and a liability and I'd honestly would not complain if a known drug abuser was unable to get malpractice insurance for anesthesiology. I think few of us think of our field this way, but being an anesthesiologist is the ultimate privilege. We, unlike just about anyone else in the hospital, can obtain and administer just about any drug to a patient without an order. We have access and opportunity that rivals the pharmacists. Speaking of, if a pharmacist was a recovering drug user should they be working in the pharmacy? Sorry, but absolutely not. Being a drug abuser (current or former) simply shows a lack of discipline and control which I think are two very important qualities for an anesthesiologist outside of medical knowledge and skill. I'm a liberal as the next man but when it comes to pride in my field I have to take a stand.

It’s not so much about pride in the field to me but about the potential to save a life. There is a lot of denial in addicts.
I feel like we have a role in saving them from themselves. And yes they can go across the street of any major medical center and score, but that will be ALL their own doing. Not associated with their job in the OR and easy access.

 

[chocomorsel]

I believe some of us who've been on this forum long enough remember an excellent resident and frequent poster here to whom this happened, and who is now a successful physician - just not in anesthesia.

This sounds familiar. Does this person practice CCM? Can’t quite place my finger on iton this Board but I met a guy in residency with a famous namesake in Anesthesia who fit the profile.

 

[chocomorsel]

Oh he was a fun resident alright (yeah think about that emoji for a second)

GYN!!! Not fun. Damn I phone and autocorrect.

 

[chocomorsel]

Personally knew a resident who got fired for "drugs", which honestly was not the entirety of the case if even. As in there were conflicting drug results and this was used as the excuse to get rid of her. There was a lot more to it, including a sexual assault that the department tried to cover up. The accused never got investigated and the department just wanted him to "graduate" since he was a senior at the time, even though he had a whole host of other issues. But hey, he had excellent grades.

She hasn't been able to get back in and this is now almost 10 years later, but she did reach a settlement with the department after years' long lawsuit and appeal. Honestly, although she had her issues, she was totally hosed and not treated appropriately during her trials and tribulations.

Another resident was an alcoholic, but I do know he was allowed to do a research year and come back. Whether or not he came back and completed, I don't know.

I remember a co-intern surgery resident from the ICU. Nicest Asian guy ever. But way too passive. He got let go after intern year and I suspect a lot of that was due to him been so passive as I saw a lot of bullying and undermining from his seniors and co interns. We had some discussions about his problems and I told him not to be so "nice", but it was not his nature. He kept thinking that if he could just "prove" himself as a good/smart surgeon, he would be OK. Ultimately, the bullies prevailed. Gotta have a tough personality in that field and not be a pushover.

 

[deleted480308]

As an anesthesia resident, I wouldn’t do a pelvic exam even if I was “invited”. Wtf is wrong with people? In fact, unless they are going into surgery, OB/gyn, or primary care, there’s no reason a med student needs to do a pelvic on an anesthetized patient. And that should be with their explicit consent.

Exactly

I did plenty of foleys or palpating rectal cancers if they were called for as part of the surgery

But a pelvic or a dre during a lap chole?

Hhhhheeeeellllllll nnnnnooooooo

 

[Psai]

Exactly

I did plenty of foleys or palpating rectal cancers if they were called for as part of the surgery

But a pelvic or a dre during a lap chole?

Hhhhheeeeellllllll nnnnnooooooo

Usually those cost extra

 

[dannyboy1]

[QUOTE="chocomorsel, post: 20038813, member
I remember a co-intern surgery resident from the ICU. Nicest Asian guy ever. But way too passive. He got let go after intern year and I suspect a lot of that was due to him been so passive as I saw a lot of bullying and undermining from his seniors and co interns. We had some discussions about his problems and I told him not to be so "nice", but it was not his nature. He kept thinking that if he could just "prove" himself as a good/smart surgeon, he would be OK. Ultimately, the bullies prevailed. Gotta have a tough personality in that field and not be a pushover.[/QUOTE]
Lol. They should have transferred him to anesthesia. Then they would have loved him, as all surgeons love an agreeable anesthesiologist that can be pushed around..

 

[deleted171991]

I hope you are not holding the initial board failure against this person. Plenty of people are practicing without Board Certification. Plenty of people pass that horrendous multiple choice exam on the second attempt. She has proven she has the knowledge by passing. Now the only thing you can hold against her are the integrity issues. We shouldn't be discriminating against people who have completed 4 years of residency based on a multiple choice exam.

Oh, please! Somebody who barely passed all her USMLE steps and failed almost all her ITEs will never be a good doctor, regardless how many "boards" s/he passes. You can fix the roof on the house all you want, as long as the foundation is rotten. And I've seen a number of these people; you just need to read their preops or their anesthetic records.

And yes, that's just another proof that our boards pass way too many people, and that anesthesiology is no rocket science. Monkey see, monkey do. Just ask the AANA.

 

[vector2]

Disagree. Many if not most people pass the written without much effort, many as CA2s. To fail them means you have some serious deficits. Isn’t the first time pass rate in the high 90s?

Absolutely agree. I took the advanced in the first year it was offered and I kind of blew it off and just studied for a few days cause I was getting hammered my first month of fellowship. Still comfortably passed even though it had a bunch of weird **** more aptly suited to an EM board exam. Unless you had some very extenuating circumstances when sitting for it, the test is easy enough that you're almost certainly unqualified to be a board certified consultant if you straight up bomb it.

 

[deleted50478]

Oh, please! Somebody who barely passed all her USMLE steps and failed almost all her ITEs will never be a good doctor, regardless how many "boards" s/he passes. You can fix the roof on the house all you want, as long as the foundation is rotten. And I've seen a number of these people; you just need to read their preops or their anesthetic records.

And yes, that's just another proof that our boards pass way too many people, and that anesthesiology is no rocket science. Monkey see, monkey do. Just ask the AANA.

Since it is widely used as a requirement for employment, the board pass rate needs to be high.

 

[pgg]

Since it is widely used as a requirement for employment, the board pass rate needs to be high.

I'm not sure that really follows. Board eligibility is generally a requirement for employment, but that's a 7 year period after residency.

 

[deleted50478]

I'm not sure that really follows. Board eligibility is generally a requirement for employment, but that's a 7 year period after residency.

I think I’ve seen ‘must be certified within 3 years’ a lot even if board eligibility is longer.

 

[dchz]

Personally knew a resident who got fired for "drugs", which honestly was not the entirety of the case if even. As in there were conflicting drug results and this was used as the excuse to get rid of her. There was a lot more to it, including a sexual assault that the department tried to cover up. The accused never got investigated and the department just wanted him to "graduate" since he was a senior at the time, even though he had a whole host of other issues. But hey, he had excellent grades.

She hasn't been able to get back in and this is now almost 10 years later, but she did reach a settlement with the department after years' long lawsuit and appeal. Honestly, although she had her issues, she was totally hosed and not treated appropriately during her trials and tribulations.

well, as long as they don't start a long interdepartment email chain blaming the lack of bonuses on the person, it should be ok.

Even if that happens, the top leadership should be able to keep their job.

 

[aneftp]

The firings were justified. Committing fraud (not showing up for rotation or filling out moonlighting slips for $300-400 extra per shift.

Those were justifiable firing. I don’t know why anyone could defend those people.

It’s take a lot to get fired from a residency. “Fired” is a loosely used word. Most residency have annual renewable contracts. But those two situations the op mentioned. 100% justifiable firing

 

[chocomorsel]

well, as long as they don't start a long interdepartment email chain blaming the lack of bonuses on the person, it should be ok.

Even if that happens, the top leadership should be able to keep their job.

Well played. lol

 

[chocomorsel]

The firings were justified. Committing fraud (not showing up for rotation or filling out moonlighting slips for $300-400 extra per shift.

Those were justifiable firing. I don’t know why anyone could defend those people.

It’s take a lot to get fired from a residency. “Fired” is a loosely used word. Most residency have annual renewable contracts. But those two situations the op mentioned. 100% justifiable firing

Agreed.

However in residency, it is extremely difficult to procure a new residency spot should you get fired for whatever reasons. I mean, getting fired in residency is almost always a career ender.

How does the rest of the world deal with getting fired? They get another job. And the law is on their side as in whether or not they give permission to the New employer to contact the last employer. Not quite so in medicine. The PD's for some reason always have to talk to each other. As in, it's hard to move to another program when you are having problems in your program, because they always want to ask of a "PD letter". Trust me, I tried. I emailed over 100 residencies when I was a resident trying to swap and the few that had a spot always had to have a PD letter. And yes, when I have to answer "yes" to a question on a medical license and hospital credentialing, I get angry. It's unnecessary scrutiny and hoops to jump through.

I feel like this is illegal and should be made illegal in the medical world. But medicine seems to fly by its own rules.
Just like when they ask about mental health issues on credentialing and licensing applications. That is illegal based on the Americans with Disabilities Act. But somehow in medicine, it is standard and you can get a license or hospital privileges denied or postponed for this s hit.

When is enough enough in medicine? When are doctors going to stand up for themselves?

I swear next year, I am going to find a lawyer to file a class action lawsuit agains the GME and the licensing boards. This crap needs to stop. I mean it's not like we are so damn privileged and respected anymore for this crap to continue. We need to rise up and stand for our rights!!!

 

[deleted480308]

Agreed.

However in residency, it is extremely difficult to procure a new residency spot should you get fired for whatever reasons. I mean, getting fired in residency is almost always a career ender.

How does the rest of the world deal with getting fired? They get another job. And the law is on their side as in whether or not they give permission to the New employer to contact the last employer. Not quite so in medicine. The PD's for some reason always have to talk to each other. As in, it's hard to move to another program when you are having problems in your program, because they always want to ask of a "PD letter". Trust me, I tried. I emailed over 100 residencies when I was a resident trying to swap and the few that had a spot always had to have a PD letter. And yes, when I have to answer "yes" to a question on a medical license and hospital credentialing, I get angry. It's unnecessary scrutiny and hoops to jump through.

I feel like this is illegal and should be made illegal in the medical world. But medicine seems to fly by its own rules.
Just like when they ask about mental health issues on credentialing and licensing applications. That is illegal based on the Americans with Disabilities Act. But somehow in medicine, it is standard and you can get a license or hospital privileges denied or postponed for this s hit.

When is enough enough in medicine? When are doctors going to stand up for themselves?

I swear next year, I am going to find a lawyer to file a class action lawsuit agains the GME and the licensing boards. This crap needs to stop. I mean it's not like we are so damn privileged and respected anymore for this crap to continue. We need to rise up and stand for our rights!!!

if the goal is to train physicians capable of ethical independent practice, then the directors need to be able to talk to each other. If a resident has a history of something out of line then it should be part of their reference if the new PD wants to call prior programs. I feel the same way for mental health issues, if it predisposes someone to issues it makes sense for an employer to want to know which is why I don't think that law makes sense