Fourth year student about to be dismissed, HELP!!

[el_duderino]

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A lot of people being absurd here. OP is a MEDICAL STUDENT. He was told to stay home by his attending. His rotation definitely included that week where he was not in; there was no intentional dishonesty. No one should be expected to go out and look for a way to keep themselves busy. He didn't work weekends during that month, should he exclude them in his paperwork? Ridiculous.

School is 100% at fault and not only should they drop this matter, they should apologize to op for causing unnecessary stress by attempting to end his career over complete garbage.

The intentional dishonesty came in when he later said he was there for four weeks, even though he took a week off.

 

[Psai]

I don't know where you people have worked in the past, but if I didn't show up a week because my (apparently brand new) immediate supervisor said he isn't starting until next week, I'd have been fired. I should have checked with his supervisor / my team lead / division head / whatever.

And if I filled out a time card later on that said I worked that week, I would have likely been docked pay and/or sued.

There's a difference between working and being a student

I will never figure out why people in this field are so interested in trying to screw over their own

 

[el_duderino]

There's a difference between working and being a student

I think that attitude is the source of the problem. I don't agree. I treat this like a job.

I don't think it's OK to expect a lower level of personal and professional responsibility from "medical student" than "person with a job."

Maybe this is why medical schools seem to value outside work experience prior to admission.

 

[JP2740]

I don't know where you people have worked in the past, but if I didn't show up a week because my (apparently brand new) immediate supervisor said he isn't starting until next week, I'd have been fired. I should have checked with his supervisor / my team lead / division head / whatever.

And if I filled out a time card later on that said I worked that week, I would have likely been docked pay and/or sued.

OP has no job, no “team lead”, no “pay”, no time card. Any other useless examples?

OP paid the school for his week off

 

[JP2740]

The intentional dishonesty came in when he later said he was there for four weeks, even though he took a week off.

He showed up on day 1. He was there.

 

[el_duderino]

OP has no job, no “team lead”, no “pay”, no time card. Any other useless examples?

OP paid the school for his week off

I was using the example of an actual job. In this case, the equivalent for "team lead" or whatever would be the clerkship coordinator, clerkship director, or clinical year dean of students.

If I were in OP's situation, there is absolutely no chance in the world I would have sat around at home for a week. I would have called or emailed the clerkship coordinator. That would have been the right thing to do.

Going ahead and taking the week off and later reporting that you were there the entire time was not the right thing to do, and I am not at all surprised by the administration's reaction. It was unprofessional and unethical.

All of this could have been easily avoided.

 

[NYCdude]

I don't know where you people have worked in the past, but if I didn't show up a week because my (apparently brand new) immediate supervisor said he isn't starting until next week, I'd have been fired. I should have checked with his supervisor / my team lead / division head / whatever.

And if I filled out a time card later on that said I worked that week, I would have likely been docked pay and/or sued.

If your supervisor gave you direct orders to stay home you'd be fired?

 

[Psai]

I was using the example of an actual job. In this case, the equivalent for "team lead" or whatever would be the clerkship coordinator, clerkship director, or clinical year dean of students.

If I were in OP's situation, there is absolutely no chance in the world I would have sat around at home for a week. I would have called or emailed the clerkship coordinator. That would have been the right thing to do.

Going ahead and taking the week off and later reporting that you were there the entire time was not the right thing to do, and I am not at all surprised by the administration's reaction. It was unprofessional and unethical.

All of this could have been easily avoided.

In your giddy rush to crucify one of your colleagues, you seem to have forgotten that you are talking to people who also have had jobs. In fact, I have one at this very moment! You don't have some sort of monopoly on gainful employment which does not pertain to OP btw.

 

[PharmlyDoc]

From an outsiders perspective in another doctorate healthcare program...in my experience, how you word things verbally and via email are extremely important. I may be able to provide help in that I work professionally in a part-time job in conjunction with being enrolled in a full-time doctorate program.

It looks like the school is correct in stating that you lied about the time period in which you participated in the rotation. And assuming the initial attending/preceptor told you to take that week off, then I hope you have email documentation/other written documentation of this. How was your rapport with the attending that emailed the school? Take time to reflect on everything good and bad during the rotation. Did you put a lot of effort into the rotation? What were the expectations of the attending? What were your expectations of yourself and your expectations of the attending? What are your (realistic) expectations of the school?

The power dynamic also plays into this. Sometimes you have to suck it up and admit you made a mistake or are at fault, and state the reasons why you're at fault, and how you've learned from it and/or positive actions you will take to correct it. In your correspondence with your US MD School, and attendings, be assertive, NOT aggressive, and be very attentive and meticulous in your wording. You have to walk a fine line between being confident and being humble. Healthcare is a small world.

Also...
Opinion | For Doctors, Age May Be More Than a Number

 

[el_duderino]

In your giddy rush to crucify one of your colleagues, you seem to have forgotten that you are talking to people who also have had jobs. In fact, I have one at this very moment! You don't have some sort of monopoly on gainful employment which does not pertain to OP btw.

I dunno about a "giddy rush to crucify" anyone, but I'm relating my own experience and opinion. OP was gone for a week and then told the administration he was there the whole time.

He should have checked that it was OK to take the week off. He should have let the clerkship coordinator and director know.

I would never have sat at home for a week during a clerkship without the people running the clerkship knowing. That's, emphatically, not something in the realm of possibility to me unless I wanted to get kicked out. And neither is lying about it afterward and saying you worked the entire time.

 

[mimelim]

Agreed. It’s a non transgression

If you did that in most residencies, you would be reprimanded. Certainly not fired, but if you think that the other residents and PD would look kindly on that, you are mistaken. Have you ever managed people? Medical students and residents are no better than high schoolers or kindergardeners at that. Independent thinkers that help take care of themselves are much easier than the, "I vas only following ze orders!" If you end up recruiting some of those people, yes, you are stuck with them because as the managers, you are ultimately responsible, but that doesn't mean that you won't select against their ilk in the future. I think that my original post in this thread was misconstrued...

As OP pointed out, there seems to be a major disconnect in philosophy between school faculty and the rest of us. Is it surprising to see @aProgDirector @Goro and @mimelim , among others, against this guy? I guess we shouldnt be surprised given that OPs administration shares a similar mentality.

My question is - does the field select for these folks who are hyper-vigilant, over the top, and willing-to-end-a-young-mans-career over what is obviously (given the overwhelming responses in favor) a minor transgression?

I am in no way, "against this guy". My comment was that this is an issue that will look extremely negatively on you. To be blunt, I don't know for sure, but I don't think that we would rank this person if we heard about something like this. I am a huge advocate (and I tell prospective residents when they interview) that my global philosophy is that if there is something going on, you should be in the hospital doing it and learning and if there isn't, you should get the **** out as quickly as possible and live the rest of your life. That philosophy depends on independent adults making real time decisions about how to use their time and puts them at least partially responsible for what/where they are. This isn't exactly ground breaking. The vast majority of residencies run in this way (albeit not explicitly stated). There is a huge difference between taking a week off and leaving early. I've had to personally deal with this as a senior resident. I've seen it happen countless times in other residencies. People "get permission" to leave from another resident or attending and disappear. Invariably, it leads to more work for others. You can have more than one boss and while it may be in YOUR interest to bounce when the attending you are working for is done for the day, that doesn't mean that you can disappear.

Attendings, senior residents etc don't know all the rules/regulations. They make mistakes all the time. They certainly have little if any training in what the rules are with medical students. It is the same in residency. I'd say that in our program there are two people that actually know the ACGME rules inside out and backwards. Everyone else just kinda makes it up and is usually half right. (which is likely better than most residencies to be honest) I am far enough removed from medical school that I honestly don't know the exact rules, but certainly in residency, there is a hard limit on the amount of time you can take off in a given year before you are not allowed to be progressed to the next year. This is a zero exception rule which usually forces people to extend their residencies for illness, pregnancy etc. If you have people disappearing for a week without it being documented/tracked appropriately, you can have serious issues down the line. The crux of the lawyer's argument is that the school is "[The school] are at fault because they were unaware I wasn't in clinic." This demonstrates that this guy's lawyer agrees with the 'obvious' that the school SHOULD know where the student is at least on a weekly basis. While we all can agree that the attending should be the 'most responsible' and reported this to the school, this could have easily been communicated to them by the student. Lets also be pretty clear here, the school did not dismiss the student. They mentioned that it was a possibility and to show up at a meeting with administration. It is impossible for any of us that were not there to know the nuances of this case and it is hard to take OPs perspective as gospel. For all we know, they were still fact finding when OP decided to bring in a lawyer.

 

[jcorpsmanMD]

I don't know where you people have worked in the past, but if I didn't show up a week because my (apparently brand new) immediate supervisor said he isn't starting until next week, I'd have been fired. I should have checked with his supervisor / my team lead / division head / whatever.

And if I filled out a time card later on that said I worked that week, I would have likely been docked pay and/or sued.

most medical students have never had real jobs.. hence they think this is okay. kid shouldn’t get dismissed, but he should at the very most been skeptical and reached out to someone to take care of his own #%*.. something everybody here should be mindful of

 

[CTFellowMD]

most medical students have never had real jobs.. hence they think this is okay. kid shouldn’t get dismissed, but he should at the very most been skeptical and reached out to someone to take care of his own #%*.. something everybody here should be mindful of

Tend to agree with this. I don't think the situation is as black and white as people here are making it out to be: he did nothing wrong VS give him the electric chair.

Did OP do something wrong? Yes. Your vacation and rotation schedule are managed by your school based on strict ACGME guidelines, not your preceptor. Is your preceptor given general control over your hours, weekends, etc? Sure. Are they allowed to just give you a random extra week off? Certainly not. OP took the risk of going along with this extra vacation, and got caught. Simple as that. If Dr. X did actually come back and put on his evaluation "I gave him the first week off because I was away, but during the other 3 weeks he did a great job," the school would still not take kindly to this and OP would still be facing some sort of remediation.

Because this thread doesn't have enough analogies and examples **sarcasm** -- If OP was on his surgical rotation, and lets say he was assigned to the colorectal team. Colorectal attending tells him "our team is all going away to the big ACRS meeting next week, just take the time off." At every where I've trained and worked, if he did that, he'd be in for some trouble. At this stage in the game (You're a MS4, assuming at least in your mid-20's with some common sense), you should realize that "hey, maybe I should check in with the the general surgery clerkship director/program director and see if I should spend time on Breast/Trauma/Surg Onc during that week."

Should he be fired? Unless there really is more to this (OP has again and again said there isn't), then no. That is absurd, especially if he is a good student otherwise. Repeating the week/rotation is fair though, +/- a mark on your record.

Regarding the whole lawyer situation -- if they were really trying to dismiss OP with no other options for remediation or ways of solving this, then he did the exactly right thing getting a lawyer. To think that this is over after one meeting though is silly. OP blindsided the administration by bringing legal representation. They are not stupid -- the schools lawyers aren't present. They will say as little as possible during that meeting and let your lawyer play his cards. They are now going to consult with their own lawyers and see if there is enough legal backing to dismiss OP. And based on the story, they could easily push the fact that OP falsified paperwork. (Doesn't matter what Dr. X did. OP asked Dr. Y to fill out an evaluation for a 4 week time period, with no mention of the first week off.)

 

[Perrotfish]

I don't know where you people have worked in the past, but if I didn't show up a week because my (apparently brand new) immediate supervisor said he isn't starting until next week, I'd have been fired

Are you sure? Have you seen this happen? Someone's immediate supervisor explicitly told them to take the day off and they were fired for it?

I have seen this situation occur in my department: a new department head have some MAs days off that she wasn't authorized to give. There was a chewing out... for the department head. There were on the other hand no consequences or harsh words for the support staff because they were following their immediate supervisor's instructions and that is a completely appropriate thing for an employee to do. They also billed for those hours on their time cards, because authorized time off is billable.

Not all situations are black and white. This one is. Whether you're a student or an employee it is always ok to follow the explicit instructions of your supervisor to go home. If those instructions are in error then the supervisor, not the student/employee, is the one who should be in trouble.

 

[Psai]

Tend to agree with this. I don't think the situation is as black and white as people here are making it out to be: he did nothing wrong VS give him the electric chair.

Did OP do something wrong? Yes. Your vacation and rotation schedule are managed by your school based on strict ACGME guidelines, not your preceptor. Is your preceptor given general control over your hours, weekends, etc? Sure. Are they allowed to just give you a random extra week off? Certainly not. OP took the risk of going along with this extra vacation, and got caught. Simple as that. If Dr. X did actually come back and put on his evaluation "I gave him the first week off because I was away, but during the other 3 weeks he did a great job," the school would still not take kindly to this and OP would still be facing some sort of remediation.

Because this thread doesn't have enough analogies and examples **sarcasm** -- If OP was on his surgical rotation, and lets say he was assigned to the colorectal team. Colorectal attending tells him "our team is all going away to the big ACRS meeting next week, just take the time off." At every where I've trained and worked, if he did that, he'd be in for some trouble. At this stage in the game (You're a MS4, assuming at least in your mid-20's with some common sense), you should realize that "hey, maybe I should check in with the the general surgery clerkship director/program director and see if I should spend time on Breast/Trauma/Surg Onc during that week."

Should he be fired? Unless there really is more to this (OP has again and again said there isn't), then no. That is absurd, especially if he is a good student otherwise. Repeating the week/rotation is fair though, +/- a mark on your record.

Regarding the whole lawyer situation -- if they were really trying to dismiss OP with no other options for remediation or ways of solving this, then he did the exactly right thing getting a lawyer. To think that this is over after one meeting though is silly. OP blindsided the administration by bringing legal representation. They are not stupid -- the schools lawyers aren't present. They will say as little as possible during that meeting and let your lawyer play his cards. They are now going to consult with their own lawyers and see if there is enough legal backing to dismiss OP. And based on the story, they could easily push the fact that OP falsified paperwork. (Doesn't matter what Dr. X did. OP asked Dr. Y to fill out an evaluation for a 4 week time period, with no mention of the first week off.)

ACGME has nothing to do with anything here. It would be the LCME.

Students shouldn't be responsible for going to their supervisor to look for things to do. He did nothing wrong.

 

[jcorpsmanMD]

ACGME has nothing to do with anything here. It would be the LCME.

Students shouldn't be responsible for going to their supervisor to look for things to do. He did nothing wrong.

He may have not done anything "wrong", I see where you are coming from. But what he did was certainly stupid..

 

[NotAProgDirector]

This is a fascinating discussion, thanks for everyone's opinions.

As OP pointed out, there seems to be a major disconnect in philosophy between school faculty and the rest of us. Is it surprising to see @aProgDirector @Goro and @mimelim , among others, against this guy? I guess we shouldnt be surprised given that OPs administration shares a similar mentality.

My question is - does the field select for these folks who are hyper-vigilant, over the top, and willing-to-end-a-young-mans-career over what is obviously (given the overwhelming responses in favor) a minor transgression?

I'm not "against" anyone. I hope that this discussion allows everyone to see the other side of the disagreement. And as I've mentioned above, "ending his career" over this is a ridiculous overreaction.

More specifically, terminating a resident is the WORST part of my job. I do everything I can to avoid that. It's a horrible situation when it has to happen, although sometimes it allows a resident to transition out of a bad situation into something where they might be more successful. I ask you to look at it this way: Perhaps I'm not "hyper vigilant, over the top", but just have a different set of standards might be worth considering.

Progdirector, who i actually really respect as a poster here and have asked advice many times, said that this was one of the most common reasons he terminates residents. I bet during orientation he does not explicitly bring up this situation as something you must tell someone in the admin. People don’t intuitively know that you have to report this situation. I bet he could’ve saved a lot of good residents over the years on this issue.

You're correct -- I don't bring this specifically up at orientation. Because I expect my residents to be professionals, and if something unexpected comes up in their schedule, I expect they will bring it to a CMR's or my attention. We do review at orientation that any and all schedule problems should be brought to our attention, and we'll address them. There's no way to go over every possible problem/issue that might come up. We expect people to use good judgement.

Regarding your last statement, you're being unfair. I've terminated a very small number of residents. And anyone terminated over an issue like this received multiple warnings beforehand, but continued to demonstrate the same behavior.

Regarding the whole lawyer situation -- if they were really trying to dismiss OP with no other options for remediation or ways of solving this, then he did the exactly right thing getting a lawyer. To think that this is over after one meeting though is silly. OP blindsided the administration by bringing legal representation. They are not stupid -- the schools lawyers aren't present. They will say as little as possible during that meeting and let your lawyer play his cards. They are now going to consult with their own lawyers and see if there is enough legal backing to dismiss OP. And based on the story, they could easily push the fact that OP falsified paperwork. (Doesn't matter what Dr. X did. OP asked Dr. Y to fill out an evaluation for a 4 week time period, with no mention of the first week off.)

I hope this all works out for the OP. As I've mentioned several times, he/she definitely doesn't deserve to be terminated over this. And calling this "dishonesty regarding reporting dates" is also over blowing it. But now the OP has escalated this by bringing a lawyer into the mix. Perhaps the school will just drop it. Or perhaps now it will be much more problematic.

Are you sure? Have you seen this happen? Someone's immediate supervisor explicitly told them to take the day off and they were fired for it?

I have seen this situation occur in my department: a new department head have some MAs days off that she wasn't authorized to give. There was a chewing out... for the department head. There were on the other hand no consequences or harsh words for the support staff because they were following their immediate supervisor's instructions and that is a completely appropriate thing for an employee to do. They also billed for those hours on their time cards, because authorized time off is billable.

Not all situations are black and white. This one is. Whether you're a student or an employee it is always ok to follow the explicit instructions of your supervisor to go home. If those instructions are in error then the supervisor, not the student/employee, is the one who should be in trouble.

I hold physicians to a higher standard than MA's. I have no problem with that. I expect a physician (or physician-in-training) to recognize that the situation is abnormal and would ask for advice about what to do next. Others (not you!) have mentioned that this means that students/residents need to "document that they didn't work weekends" or other nonsense. Everyone expects that you'll have weekends and holidays off when you're on an elective, getting an entire extra week off is hugely abnormal.

ACGME has nothing to do with anything here. It would be the LCME.

Students shouldn't be responsible for going to their supervisor to look for things to do. He did nothing wrong.

We've posted both resident and student examples, but in any case neither he ACGME nor the LCME is going to get into details such as this.

Regarding whether the rules should be different for students vs residents (students vs employees), I see medical school as direct training for residency, hence I think the standards should be the same.

----

This discussion really highlights the difficulty of defining "professional behavior". I doubt anyone will change their mind based upon this discussion, but I hope that both sides can see the other's viewpoint. And perhaps that's the important lesson to take away from this -- when assessing whether an action is professional or not, it's important to consider how other's might view the same situation. Not that we should have a "majority rules" version of professionalism, but that there may be several different viewpoints that are worth considering.

 

[CTFellowMD]

Students shouldn't be responsible for going to their supervisor to look for things to do. He did nothing wrong.

Completely disagree here. His preceptor may evealuate him, but it is his school that determines if he graduates. He knew he had a 4 week rotation, did 3 weeks, yet reported the full 4. That is wrong.

 

[CTFellowMD]

So for everyone saying that since the preceptor instructed him to take the time off, the OP did nothing wrong. I have a question -- where is the line? At what point is it the student's responsibility to notify the school, or seek out other opportunities?

If the preceptor told him to take 2 weeks off? 3 weeks? What if he said that he's too busy for the student, and the OP should just come in every day for 20 minutes to document he was there? Is that ok?

 

[68PGunner]

I still don’t see how if I skipped work for a week because my immediate supervisor told me not to show up would be a “minor transgression”

You’re a first year medical student, so you are kind of new. OP was screwed either ways. If he had reported the week off to the school, the school might call the preceptor and OP would be at risk of pissing off the preceptor and thereby receiving a failing grade from the physician. A failed rotation would literally end your residency application where you would be grouped w/ IMG Caribbean students.

 

[DBV]

I really don't understand the outrage about op listing the dates. The rotation block is from x to y. He wrote that. It's not about taking credit it's about documenting the correct rotation block.

I'm not a lawyer but I would be surprised if a halfway decent one couldn't make this argument and have it stick.

 

[JP2740]

So for everyone saying that since the preceptor instructed him to take the time off, the OP did nothing wrong. I have a question -- where is the line? At what point is it the student's responsibility to notify the school, or seek out other opportunities?

If the preceptor told him to take 2 weeks off? 3 weeks? What if he said that he's too busy for the student, and the OP should just come in every day for 20 minutes to document he was there? Is that ok?

You’re a CT fellow though. Glutton for punishment

 

[Game Changer 99]

There seem to be a few things that are being misunderstand.

My evaluation lists rotation dates, these dates are the ones assigned by my school. They run from Sunday to Saturday, even if you don't show up on Sunday. My school doesn't seem to be implying that I lied because I included the week I was told to stay home as the start date. I did show up the first Monday and my attending wasn't seeing patients that day, he was just in the office finishing some stuff up before he left for his flight in a few hours. My school doesn't require any type of log for specific days or hours worked. For example, our EM rotation requires completing ten shifts over a four week period. I completed my ten shifts in 15 days, I had a two week break. I suppose my evaluation submitted was fraudulent since I listed the four week period.

I'm not sure why we are comparing residency to medical school. Apples and oranges. In residency, one is working (earning income), totally different set of circumstances.

Throwing around the dismissal word is cruel for any medical school to do over this. No rational person would ever consider dismissal as an option for this, it shouldn't even be in the discussion. This does show the incredible power imbalance. The medical school is the judge, jury, and executioner. Most medical students either can't afford an attorney or think they don't need one, they allow schools to bully around students and misrepresent the facts. The facts in this situation are I pay tuition to my school and they set me up with an attending who told me to take the week off (despite me asking if I should find another attending) and I followed his directions. Only in education could I be punished. My school seems to think they made no wrongs in this area. Do any of you crazy pro-administration people think the school is at fault, even a little?

To this point, we will see if Dr. X is contacted. My school believes me about being told to take the week off. For this reason, I don't think contacting Dr. X will likely benefit me or strengthen the school's position. For lawyer is handling contacting Dr. X, but he said it probably won't have much impact.

 

[Game Changer 99]

This is a fascinating discussion, thanks for everyone's opinions.



I'm not "against" anyone. I hope that this discussion allows everyone to see the other side of the disagreement. And as I've mentioned above, "ending his career" over this is a ridiculous overreaction.

More specifically, terminating a resident is the WORST part of my job. I do everything I can to avoid that. It's a horrible situation when it has to happen, although sometimes it allows a resident to transition out of a bad situation into something where they might be more successful. I ask you to look at it this way: Perhaps I'm not "hyper vigilant, over the top", but just have a different set of standards might be worth considering.



You're correct -- I don't bring this specifically up at orientation. Because I expect my residents to be professionals, and if something unexpected comes up in their schedule, I expect they will bring it to a CMR's or my attention. We do review at orientation that any and all schedule problems should be brought to our attention, and we'll address them. There's no way to go over every possible problem/issue that might come up. We expect people to use good judgement.

Regarding your last statement, you're being unfair. I've terminated a very small number of residents. And anyone terminated over an issue like this received multiple warnings beforehand, but continued to demonstrate the same behavior.



I hope this all works out for the OP. As I've mentioned several times, he/she definitely doesn't deserve to be terminated over this. And calling this "dishonesty regarding reporting dates" is also over blowing it. But now the OP has escalated this by bringing a lawyer into the mix. Perhaps the school will just drop it. Or perhaps now it will be much more problematic.



I hold physicians to a higher standard than MA's. I have no problem with that. I expect a physician (or physician-in-training) to recognize that the situation is abnormal and would ask for advice about what to do next. Others (not you!) have mentioned that this means that students/residents need to "document that they didn't work weekends" or other nonsense. Everyone expects that you'll have weekends and holidays off when you're on an elective, getting an entire extra week off is hugely abnormal.



We've posted both resident and student examples, but in any case neither he ACGME nor the LCME is going to get into details such as this.

Regarding whether the rules should be different for students vs residents (students vs employees), I see medical school as direct training for residency, hence I think the standards should be the same.

----

This discussion really highlights the difficulty of defining "professional behavior". I doubt anyone will change their mind based upon this discussion, but I hope that both sides can see the other's viewpoint. And perhaps that's the important lesson to take away from this -- when assessing whether an action is professional or not, it's important to consider how other's might view the same situation. Not that we should have a "majority rules" version of professionalism, but that there may be several different viewpoints that are worth considering.

It would be interesting to have you discuss this from the perspective of a medical student and in the context of medical school. Residency is a totally different ball game. Do you fault my school at all? Shouldn't the largest share of the blame be on my school?

 

[Game Changer 99]

I'm trying to say this in the nicest possible way, but you seem to have trouble understanding plain English.

You appear to have screwed up by falsifying your paperwork. At least, this is what I am interpreting from your posts, and other people are saying the exact same thing.

And I'm not an administrator, I work for a living...I teach medical students.

Now stop going loose cannon on us.

I didn't falsify any paperwork, you are misrepresenting the situation for your convenience. You could use a good "dope slap" just for that. I understand English perfectly fine, don't insult my intelligence to make your point. You could use another good "dope slap" for that too.

Sure, you work for a living. Teaching the same recycled lectures year after year. Clearly, you share the same views as the administration in blaming me for following the instructions an attending who was assigned to me by my school. Sounds like you possess the type of twisted logic used by my school.

 

[Newyawk]

honestly I'm a little surprised you opted to get a lawyer (unless it was a relative or close friend or something). if it were me, I would be so convinced I was right that I would have enough faith in my own argumentative skills and in the rationale of a group of educated people vs one dean (who btw, we still dk actually legitimately threatened dismissal)

 

[Game Changer 99]

A lot of people being absurd here. OP is a MEDICAL STUDENT. He was told to stay home by his attending. His rotation definitely included that week where he was not in; there was no intentional dishonesty. No one should be expected to go out and look for a way to keep themselves busy. He didn't work weekends during that month, should he exclude them in his paperwork? Ridiculous.

School is 100% at fault and not only should they drop this matter, they should apologize to op for causing unnecessary stress by attempting to end his career over complete garbage.

Well put, anyone who thinks dismissal or academic dishonesty should be on my record is being entirely irrational. The thought that people believe this should impact my residency placement and medical school graduation have lost their mind.

 

[operaman]

I wonder how much of this couldn’t be prevented by the institutions better communicating their expectations. However people come down on OP, we can all agree that even within this thread there are varying interpretations of whether or not his behavior was appropriate and professional. These are precisely the times when a clearer policy can help prevent confusion.

My family med clerkship was done st multiple sites throughout the state. We had a clearly written policy stating that all absences had to be approved by the clerkship director and that we were required to let the clerkship director know immediately if our preceptor was not going to be present for any length of time so that arrangements could be made. These occasions were rare but they did make an effort to temporarily place impacted students in other offices while their assigned preceptor was away.

From my read, there seems to have been some ambiguity regarding whom the student was ultimately responsible to. Some logically conclude its The immediately supervising attending; others feel it would be the clerkship director as they are truly responsible and assign final grades and whatnot. Again, this is precisely where a clearly written policy could make all this ambiguity go away.

One point to add for the OP: you need to keep your nose clean for the rest of the year until you graduate. You definitely have a target on you now. Frequently people get away with the first transgression but get nailed on future little things that would usually fly under the radar. Make sure you do everything required on time, never be late, don’t leave early (hard during fourth year!) and don’t give anyone any ammunition to use against you. Any slip up has potential to become ammunition and construed to be a pattern of unprofessional behavior. Be careful.

 

[Game Changer 99]

honestly I'm a little surprised you opted to get a lawyer (unless it was a relative or close friend or something). if it were me, I would be so convinced I was right that I would have enough faith in my own argumentative skills and in the rationale of a group of educated people vs one dean (who btw, we still dk actually legitimately threatened dismissal)

I had the same thought about being right and not needing a lawyer. The thing people in my position need to learn is as follows: being in the right (like I am) and winning the argument against the administration are totally different. Given my school's initial position, it is entirely possible I could have been dismissed or had some type of academic dishonesty charge listed on my transcript in addition to having to make up the week or rotation AND not matching into any of the radiology residency programs. I'm not willing to accept any of those since I did nothing wrong. The more I think about it, the more I am coming to the conclusion getting a lawyer was the right thing to do. It is expensive while at the same time very cheap considering the potential bad outcomes that could result because of the witch hunt my school has engaged in.

 

[Newyawk]

I also wonder how much of this stems from the hyper-competitive environment that pervades the halls of ivory tower medical schools. Interestingly, these students are often the same professionals who take these positions later in life.
I remember one instance early on in med school where a google doc was being made with questions that students had created. The professor allowed us each to make one question and said they would add it to the exam. A few of the students, all of whom were the nauseatingly competitive type, decided to complain that the doc should be deleted because it is unethical (to their credit they complained to the class reps, not the professor). The real question was - after the google doc wasn't deleted and every student in the class used it - did these students stay on their high horse in the name of their own ethics? Or did they use it anyway? This begs the question - did they actually care about the ethical implications, or were they only concerned with their own competitive advantage over their peers being diminished by the google doc?

 

[Game Changer 99]

I wonder how much of this couldn’t be prevented by the institutions better communicating their expectations. However people come down on OP, we can all agree that even within this thread there are varying interpretations of whether or not his behavior was appropriate and professional. These are precisely the times when a clearer policy can help prevent confusion.

My family med clerkship was done st multiple sites throughout the state. We had a clearly written policy stating that all absences had to be approved by the clerkship director and that we were required to let the clerkship director know immediately if our preceptor was not going to be present for any length of time so that arrangements could be made. These occasions were rare but they did make an effort to temporarily place impacted students in other offices while their assigned preceptor was away.

From my read, there seems to have been some ambiguity regarding whom the student was ultimately responsible to. Some logically conclude its The immediately supervising attending; others feel it would be the clerkship director as they are truly responsible and assign final grades and whatnot. Again, this is precisely where a clearly written policy could make all this ambiguity go away.

One point to add for the OP: you need to keep your nose clean for the rest of the year until you graduate. You definitely have a target on you now. Frequently people get away with the first transgression but get nailed on future little things that would usually fly under the radar. Make sure you do everything required on time, never be late, don’t leave early (hard during fourth year!) and don’t give anyone any ammunition to use against you. Any slip up has potential to become ammunition and construed to be a pattern of unprofessional behavior. Be careful.

I'm listing dates and times for the rest of my rotations and will include that on all of my evaluations from here on out. Partially to be sly and partially to emphasize the point. The impression that I have gotten from my school is our attending is in charge, do as told. That is how things work. The outpatient family medicine rotations are pretty messy for the most part and we are placed with someone to spend the entire four weeks with. There isn't any specific policy in place regarding this type of situation which created the perfect environment for my school to come after me. I believe many schools intentionally have very ambiguous policies so they can come down on people however they want.

 

[chasm-e-baddoor]

If you did that in most residencies, you would be reprimanded. Certainly not fired, but if you think that the other residents and PD would look kindly on that, you are mistaken. Have you ever managed people? Medical students and residents are no better than high schoolers or kindergardeners at that. Independent thinkers that help take care of themselves are much easier than the, "I vas only following ze orders!" If you end up recruiting some of those people, yes, you are stuck with them because as the managers, you are ultimately responsible, but that doesn't mean that you won't select against their ilk in the future. I think that my original post in this thread was misconstrued...

"certainly not fired, but..." that's the whole point of this topic

Not sure if you realize, but TC is not a resident, but a medical student; and TC is not being merely reprimanded, he's being threatened to have his career and life endeavor ended. TC has stated multiple times that he is willing to be "reprimanded" by making up the entire rotation or something if necessary - anything to save his career. This would be a non-issue if things were so simple. But here we are, with TC's life investment in jeopardy.

and lol @ pulling the independent thinker card for this nonsense when throughout the whole medical training pathway students are at the bottom of the totem pole expected to be subservient yes-men who are expected to dance to the doctors' whims or else risk their evaluations...same as when you're a resident you're at the complete mercy of senior residents and attendings.

I am in no way, "against this guy". My comment was that this is an issue that will look extremely negatively on you. To be blunt, I don't know for sure, but I don't think that we would rank this person if we heard about something like this. I am a huge advocate (and I tell prospective residents when they interview) that my global philosophy is that if there is something going on, you should be in the hospital doing it and learning and if there isn't, you should get the **** out as quickly as possible and live the rest of your life. That philosophy depends on independent adults making real time decisions about how to use their time and puts them at least partially responsible for what/where they are. This isn't exactly ground breaking. The vast majority of residencies run in this way (albeit not explicitly stated). There is a huge difference between taking a week off and leaving early. I've had to personally deal with this as a senior resident. I've seen it happen countless times in other residencies. People "get permission" to leave from another resident or attending and disappear. Invariably, it leads to more work for others. You can have more than one boss and while it may be in YOUR interest to bounce when the attending you are working for is done for the day, that doesn't mean that you can disappear.

I dont think you understand the situation. This person is not a paid resident PHYSICIAN, but a paying student, and this person was not at a hospital but a private out-patient clinic. I dont know what kind of rotations you did as a student, but if the single attending that you were assigned to told you to not come in for a week, would you still go there and wander around the clinic bothering paid staff (who you were not assigned to) looking for stuff to do? That is unprofessional.

Attendings, senior residents etc don't know all the rules/regulations. They make mistakes all the time. They certainly have little if any training in what the rules are with medical students. It is the same in residency. I'd say that in our program there are two people that actually know the ACGME rules inside out and backwards. Everyone else just kinda makes it up and is usually half right. (which is likely better than most residencies to be honest) I am far enough removed from medical school that I honestly don't know the exact rules, but certainly in residency, there is a hard limit on the amount of time you can take off in a given year before you are not allowed to be progressed to the next year. This is a zero exception rule which usually forces people to extend their residencies for illness, pregnancy etc. If you have people disappearing for a week without it being documented/tracked appropriately, you can have serious issues down the line. The crux of the lawyer's argument is that the school is "[The school] are at fault because they were unaware I wasn't in clinic." This demonstrates that this guy's lawyer agrees with the 'obvious' that the school SHOULD know where the student is at least on a weekly basis. While we all can agree that the attending should be the 'most responsible' and reported this to the school, this could have easily been communicated to them by the student. Lets also be pretty clear here, the school did not dismiss the student. They mentioned that it was a possibility and to show up at a meeting with administration. It is impossible for any of us that were not there to know the nuances of this case and it is hard to take OPs perspective as gospel. For all we know, they were still fact finding when OP decided to bring in a lawyer.

So it's okay for the Attendings to not know the rules, it's okay for the school to not make sure that the doctors that the student is paying for know the rules, but it's career ending if a student makes what at worst would be an honest mistake?

You and the school believe that the only party that can be held responsible for anything, and the only party susceptible to the highest level of punishment, is the student. That is where the lawyer's argument comes in. There is no problem with the lawyer's argument.

And if the school were still fact finding, it makes what they did to TC even more ridiculous...shaking him down without all the facts.

 

[Game Changer 99]

I also wonder how much of this stems from the hyper-competitive environment that pervades the halls of ivory tower medical schools. Interestingly, these students are often the same professionals who take these positions later in life.
I remember one instance early on in med school where a google doc was being made with questions that students had created. The professor allowed us each to make one question and said they would add it to the exam. A few of the students, all of whom were the nauseatingly competitive type, decided to complain that the doc should be deleted because it is unethical (to their credit they complained to the class reps, not the professor). The real question was - after the google doc wasn't deleted and every student in the class used it - did these students stay on their high horse in the name of their own ethics? Or did they use it anyway? This begs the question - did they actually care about the ethical implications, or were they only concerned with their own competitive advantage over their peers being diminished by the google doc?

No doubt they were concerned with their own competitive advantage. These same deans and administrators who preach professionalism are the same unethical people who will do anything to gain an advantage.

 

[mehc012]

In my experience, med schools throw around 'possibility of expulsion' whenever they want you to pay serious attention. Pretty much every student, myself included, that I've seen brought up for minor professionalism things (aka things that were dismissed by the committee without even so much as a slap on the wrist) went into their meeting convinced that expulsion was a major possibility. It's bogus, and it's a cruel way to reinforce the idea that they take professionalism seriously...but it's effective, I suppose.

 

[mehc012]

I also wonder how much of this stems from the hyper-competitive environment that pervades the halls of ivory tower medical schools. Interestingly, these students are often the same professionals who take these positions later in life.
I remember one instance early on in med school where a google doc was being made with questions that students had created. The professor allowed us each to make one question and said they would add it to the exam. A few of the students, all of whom were the nauseatingly competitive type, decided to complain that the doc should be deleted because it is unethical (to their credit they complained to the class reps, not the professor). The real question was - after the google doc wasn't deleted and every student in the class used it - did these students stay on their high horse in the name of their own ethics? Or did they use it anyway? This begs the question - did they actually care about the ethical implications, or were they only concerned with their own competitive advantage over their peers being diminished by the google doc?

We had a faculty member openly divulge the subjects of our test questions to a few students, who to their credit, recorded it and shared a doc of the subject list with most of the class (some people weren't in the file sharing site where they posted it). Not only were our classmates proactive about making sure that everyone who wanted had access to the doc, but a reasonably high number of us (myself included) decided that this was ethically sketchy and refused to read it or study with people who would talk about it/have it guide study topics in the group setting. From what I can tell, nobody got in trouble because the students did nothing but share the information with their classmates to prevent unfair advantage; it was given unsolicited by a faculty member who knew people were stressed about the upcoming exam and was just trying to help, but took the conversation too far.

 

[mimelim]

"certainly not fired, but..." that's the whole point of this topic

Not sure if you realize, but TC is not a resident, but a medical student; and TC is not being merely reprimanded, he's being threatened to have his career and life endeavor ended. TC has stated multiple times that he is willing to be "reprimanded" by making up the entire rotation or something if necessary - anything to save his career. This would be a non-issue if things were so simple. But here we are, with TC's life investment in jeopardy.

and lol @ pulling the independent thinker card for this nonsense when throughout the whole medical training pathway students are at the bottom of the totem pole expected to be subservient yes-men who are expected to dance to the doctors' whims or else risk their evaluations...same as when you're a resident you're at the complete mercy of senior residents and attendings.



I dont think you understand the situation. This person is not a paid resident PHYSICIAN, but a paying student, and this person was not at a hospital but a private out-patient clinic. I dont know what kind of rotations you did as a student, but if the single attending that you were assigned to told you to not come in for a week, would you still go there and wander around the clinic bothering paid staff (who you were not assigned to) looking for stuff to do? That is unprofessional.



So it's okay for the Attendings to not know the rules, it's okay for the school to not make sure that the doctors that the student is paying for know the rules, but it's career ending if a student makes what at worst would be an honest mistake?

You and the school believe that the only party that can be held responsible for anything, and the only party susceptible to the highest level of punishment, is the student. That is where the lawyer's argument comes in. There is no problem with the lawyer's argument.

And if the school were still fact finding, it makes what they did to TC even more ridiculous...shaking him down without all the facts.

I tried reading your responses, but realized that you didn't read anything that you quoted and just started typing responses to something else entirely. Kind of hard to have a conversation when you just ignore what other people write and just rant. Would suggest you actually read what is written so we could actually have a discussion.

 

[Lawpy]

I just want to clarify one thing. If what OP said is true, could we at least agree that OP's school is dramatically overreacting by threatening to terminate OP's career over what seems to be a very very minor transgression? Because I don't see any justification for what the school did, as threatening dismissal is simply outright cruel and heartless.

 

[Goro]

I just want to clarify one thing. If what OP said is true, could we at least agree that OP's school is dramatically overreacting by threatening to terminate OP's career over what seems to be a very very minor transgression? Because I don't see any justification for what the school did, as threatening dismissal is simply outright cruel and heartless.

IF what OP said was true, then you are correct. Having the word "dismissal" in a conversation about some seemingly minor paperwork issues is overkill. But I'm surprised that so many people are going on about the missed time, when it's the misreporting of the paperwork that's the issue. It wasn't the Watergate break in that brought down Richard Nixon, it was the coverup/obstruction of justice that did it.

However, Lawper, I think that you've been on SDN long enough to know that with these types of threads, there is always more to the story than the OPs let on.

And seeing how this OP is now lashing out against multiple people offering mere input and actual helpful advice in the style of He Who Must Not Be Named confirms my suspicion that that this isn't the only time OP has gotten onto the school's radar.

We once had a student faced with professionalism issues (and deserved it) also lawyer up, and our Dean folded immediately as well, much to our dismay. But said student never graduated anyway. Actions do have consequences.

 

[NotAProgDirector]

It would be interesting to have you discuss this from the perspective of a medical student and in the context of medical school. Residency is a totally different ball game. Do you fault my school at all? Shouldn't the largest share of the blame be on my school?

In most/all of my comments, I've said that the faculty member involved deserves much of the blame for this.

I just want to clarify one thing. If what OP said is true, could we at least agree that OP's school is dramatically overreacting by threatening to terminate OP's career over what seems to be a very very minor transgression? Because I don't see any justification for what the school did, as threatening dismissal is simply outright cruel and heartless.

Depends on the details. If they in fact "threatened to terminate him" over this, then yes. But what if they just sent a "boiler plate" email saying "You are required to come to a meeting to meet with Dean X regarding this issue. The (insert appropriate committee name here) committee will review the details of the issue and determine the appropriate response, which could include any combination of an official reprimand in your file, failing the clerkship, repeating the year, or expulsion from school." I can see how someone might interpret this email as "they are threatening to expel me", but that's not what's really happening -- they send this email to everyone in a similar situation, to cover all the bases. And, as mentioned above, to ensure that the student recognizes that it may be serious. (Note: I have no idea what actually ensued here, this is just an example). Even if this was the case in this situation, the school should do a better job to avoid students misinterpreting and panicking about something like this.

 

[NotAProgDirector]

For example, our EM rotation requires completing ten shifts over a four week period. I completed my ten shifts in 15 days, I had a two week break. I suppose my evaluation submitted was fraudulent since I listed the four week period.

If they are clear that you need to do 10 shifts in 4 weeks, and you complete all 10 in 2 weeks, then I have no problem scheduling no shifts over the last 2 weeks. Personally, I think having students only work 10 shifts in 4 weeks is ridiculous, but if that's the policy, then that's the way it is.

I don't think this is comparable to the issue at hand, since it's implied that you would work all business days during your assignment. And that's the crux of this discussion -- I think it's implied that you would work all business days during your assignment. Your opinion (matched by others here) is that you should work whatever days the faculty member tells you to. Which is "correct" is a matter of debate.

 

[JP2740]

I wonder how much of this couldn’t be prevented by the institutions better communicating their expectations. However people come down on OP, we can all agree that even within this thread there are varying interpretations of whether or not his behavior was appropriate and professional. These are precisely the times when a clearer policy can help prevent confusion.

My family med clerkship was done st multiple sites throughout the state. We had a clearly written policy stating that all absences had to be approved by the clerkship director and that we were required to let the clerkship director know immediately if our preceptor was not going to be present for any length of time so that arrangements could be made. These occasions were rare but they did make an effort to temporarily place impacted students in other offices while their assigned preceptor was away.

From my read, there seems to have been some ambiguity regarding whom the student was ultimately responsible to. Some logically conclude its The immediately supervising attending; others feel it would be the clerkship director as they are truly responsible and assign final grades and whatnot. Again, this is precisely where a clearly written policy could make all this ambiguity go away.

One point to add for the OP: you need to keep your nose clean for the rest of the year until you graduate. You definitely have a target on you now. Frequently people get away with the first transgression but get nailed on future little things that would usually fly under the radar. Make sure you do everything required on time, never be late, don’t leave early (hard during fourth year!) and don’t give anyone any ammunition to use against you. Any slip up has potential to become ammunition and construed to be a pattern of unprofessional behavior. Be careful.

Yes, and I think this perspective is helpful: he did not intentionally break a clear cut rule. If this was clearly stated, then I truly believe OP is the kind of person who would have reported this. He did not think to himself, this is the wrong thing to do, then went ahead with it.

 

[el_duderino]

OP's responsibility is not to his preceptor.

It's to his institution.

He lied to his institution, covering up the time his preceptor gave him off.

 

[Game Changer 99]

If they are clear that you need to do 10 shifts in 4 weeks, and you complete all 10 in 2 weeks, then I have no problem scheduling no shifts over the last 2 weeks. Personally, I think having students only work 10 shifts in 4 weeks is ridiculous, but if that's the policy, then that's the way it is.

I don't think this is comparable to the issue at hand, since it's implied that you would work all business days during your assignment. And that's the crux of this discussion -- I think it's implied that you would work all business days during your assignment. Your opinion (matched by others here) is that you should work whatever days the faculty member tells you to. Which is "correct" is a matter of debate.

Third year EM electives require 14 shifts. Fourth year EM electives only require 10 shifts because it is intended to be scheduled during interview season. Most of my classmates haven't even been able to complete 10 shifts due to so many interviews.

 

[Game Changer 99]

OP's responsibility is not to his preceptor.

It's to his institution.

He lied to his institution, covering up the time his preceptor gave him off.

This has to be the stupidest thing I have ever read. My attending worked for my institution and my responsibility is to my attending. My attending was my institution for this rotation. WTF are you talking about?

The twisted logic you are implementing is precisely the reason why my school is acting so irrationally.

 

[Game Changer 99]

Yes, and I think this perspective is helpful: he did not intentionally break a clear cut rule. If this was clearly stated, then I truly believe OP is the kind of person who would have reported this. He did not think to himself, this is the wrong thing to do, then went ahead with it.

I got the week off, didn't think I was doing anything wrong at the time. As I type this, I still don't think I did anything wrong. Probably doesn't make much difference, but the three weeks I spent with Dr. Y were Monday through Saturday 7 AM to 6:30 PM and 8 AM to 1 PM on Saturday. I easily have enough extra hours for an outpatient clinic to make up for the missed week since my school failed to provide me with rotation for this week.

 

[el_duderino]

My attending worked for my institution and my responsibility is to my attending. My attending was my institution for this rotation. WTF are you talking about?

The twisted logic you are implementing is precisely the reason why my school is acting so irrationally.

Uh, no. It's your school that is licensed by the LCME. It's your school that is contractually obligated to make sure you get a certain amount of clinical exposure in specified fields, and all the other things. Those are LCME requirements.

It's your school's responsibility to make sure its students are getting an appropriate education. Your responsibility as a student is not to lie to the school about the experience and education you're getting. You knew you weren't supposed to just have a random extra week off from your clerkship. I presume you knew that, anyway. From what you're posting here it doesn't sound like you understand who is responsible for what.

It would never, ever have occurred to me to take a week off just because my preceptor said to, without checking with the clerkship coordinator or director. Ever.

Maybe a few hours here or there without telling anyone, but a week? Yeesh.

 

[el_duderino]

I got the week off, didn't think I was doing anything wrong at the time. As I type this, I still don't think I did anything wrong. Probably doesn't make much difference, but the three weeks I spent with Dr. Y were Monday through Saturday 7 AM to 6:30 PM and 8 AM to 1 PM on Saturday. I easily have enough extra hours for an outpatient clinic to make up for the missed week since my school failed to provide me with rotation for this week.

You didn't get the week off. It's not your preceptor's job to unilaterally give you an entire week off, and I think you know that. The school isn't allowed to do that, per requirements.

If you "got the week off," you were obligated to make sure they knew that because they have a responsibility to their licensing organization.

Imagine if he gave you the entire clerkship off because he'd just rather not have students.

 

[Game Changer 99]

Uh, no. It's your school that is licensed by the LCME. It's your school that is contractually obligated to make sure you get a certain amount of clinical exposure in specified fields, and all the other things. Those are LCME requirements.

It's your school's responsibility to make sure its students are getting an appropriate education. Your responsibility as a student is not to lie to the school about the experience and education you're getting. You knew you weren't supposed to just have a random extra week off from your clerkship. I presume you knew that, anyway. From what you're posting here it doesn't sound like you understand who is responsible for what.

It would never, ever have occurred to me to take a week off just because my preceptor said to, without checking with the clerkship coordinator or director. Ever.

Maybe a few hours here or there without telling anyone, but a week? Yeesh.

Uh, you're wrong. My school set me up with this attending. My job as a student is to do what my attending tells me to do, including when to come in to clinic. In no way did I ever lie about the experience or education I was getting.

You are such a better person than me, I will strive to reach the impossibly high ethical standards you have set forth.

 

[el_duderino]

Uh, you're wrong. My school set me up with this attending. My job as a student is to do what my attending tells me to do, including when to come in to clinic. In no way did I ever lie about the experience or education I was getting.

You are such a better person than me, I will strive to reach the impossibly high ethical standards you have set forth.

You are not understanding the administration's position, and you are refusing to learn what the school's obligations are.

You are refusing to understand what the actual responsibilities of the school administration are.

The preceptor messed up, but so did you. You should have known better.

 

[Game Changer 99]

You didn't get the week off. It's not your preceptor's job to unilaterally give you an entire week off, and I think you know that. The school isn't allowed to do that, per requirements.

If you "got the week off," you were obligated to make sure they knew that because they have a responsibility to their licensing organization.

Imagine if he gave you the entire clerkship off because he'd just rather not have students.

During interview season, students actually miss most days of a rotation and sometimes the whole thing. My attending is my boss, I do as they say, and am not "obligated" to make sure anyone else knows anything. That is a double edged sword, clearly a no win situation. Especially after I offered to find another attending and Dr. X insisted that I take the week off.