Gen surg intern on probation with talk of dismal

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novidedos

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It’s been a tough gen surg intern year. I was told three weeks into intern year that I was behind my class and could be held back if I don’t improve. I thought I was doing better but last January I was put on remediation. I improved on all deficiencies except clinical judgement last time I spoke with PD last month and that was why they were holding me back. I just met with her and now new deficiencies are brought up and I will be out on 3 month probation with possibility of dismissal now. I struggled with clinical skills from the beginning. My 3rd and 4th yrs in Med school were not clinically challenging bc of the type of rotations I chose . I stayed in regional campus instead of moving down to academic center. I got great surgery skills bc there were no residents, but the problem was there were no residents, no rounding, no note to be written. In hindsight it was just a lot of shadowing. It caught up with me intern year. Being behind and an introvert I also was not very liked by residents. I worked my tail off trying to improve but my clinical judgement was not there from feedback. I also did not take responsibility for my deficiencies initially and blamed it on the residents not liking me. That only made things worse. Needless to say, the program director said I was definitely going to be held back one year which I accepted and came to terms with. But I met with her today and my situation is way worse. I’m on 3 month probation and if I don’t improve they will dismiss me. Considering that I worked my tail off trying to improve up to now, I do not think I have much hope things will work out. I can make an appeal to extend my probation 6 months or 1 year but not guaranteed. I do not know how I got to this point but it really looks like they don’t want me here. If and when it comes to dismissal She will give me chance to resign so that I can apply elsewhere. I don’t know how it got so bad. A part of me still wants to believe I have a chance here, as some residents try to tell me, but reality tends to point to worse case scenario. I accepted responsibility and apologized to PD and others for not taking ownership of my deficiencies which I could not accept initially. They say that it the first step to improvement. But I have no guarantee there will be happy ending. Any advice?

What chance do I have to transfer to another residency like ER or anesthesia with these “clinical deficiency” and probation in my record. Who would accept me. Psych? Thanks for your input. At rock bottom right now

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For what it’s worth, I’m sorry this happening
 
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You still have a shot. Remediation is not dismissal and your program felt it was worth keeping you rather than not renewing your contract outright.

I would take it day by day and if you have a chief resident that is halfway decent, you could meet with them for honest assessment of how you could improve. It sounds like you're taking responsibility, and yes you still need to improve the clinical deficiency. Is it your academic scores holding you back? Presentations? Notes?

Did you jeopardize patient safety at any point? If it's clinical judgment lacking and you're on service - I'd read up/know the basics of managing, and then run it by a senior resident prior to presenting the plan to the attending. Every morning, come early, read up on patients, have an idea what the plan is/what you would do next if x, y, z happened, and barriers to discharge. Medicine is usually very predictable - you learn what each attending wants to know (I/O's, dvt prophylaxis, diet, etc).

Sorry though, this sucks, keep your head up.
 
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It’s been a tough gen surg intern year. I was told three weeks into intern year that I was behind my class and could be held back if I don’t improve. I thought I was doing better but last January I was put on remediation. I improved on all deficiencies except clinical judgement last time I spoke with PD last month and that was why they were holding me back. I just met with her and now new deficiencies are brought up and I will be out on 3 month probation with possibility of dismissal now. I struggled with clinical skills from the beginning. My 3rd and 4th yrs in Med school were not clinically challenging bc of the type of rotations I chose . I stayed in regional campus instead of moving down to academic center. I got great surgery skills bc there were no residents, but the problem was there were no residents, no rounding, no note to be written. In hindsight it was just a lot of shadowing. It caught up with me intern year. Being behind and an introvert I also was not very liked by residents. I worked my tail off trying to improve but my clinical judgement was not there from feedback. I also did not take responsibility for my deficiencies initially and blamed it on the residents not liking me. That only made things worse. Needless to say, the program director said I was definitely going to be held back one year which I accepted and came to terms with. But I met with her today and my situation is way worse. I’m on 3 month probation and if I don’t improve they will dismiss me. Considering that I worked my tail off trying to improve up to now, I do not think I have much hope things will work out. I can make an appeal to extend my probation 6 months or 1 year but not guaranteed. I do not know how I got to this point but it really looks like they don’t want me here. If and when it comes to dismissal She will give me chance to resign so that I can apply elsewhere. I don’t know how it got so bad. A part of me still wants to believe I have a chance here, as some residents try to tell me, but reality tends to point to worse case scenario. I accepted responsibility and apologized to PD and others for not taking ownership of my deficiencies which I could not accept initially. They say that it the first step to improvement. But I have no guarantee there will be happy ending. Any advice?

What chance do I have to transfer to another residency like ER or anesthesia with these “clinical deficiency” and probation in my record. Who would accept me. Psych? Thanks for your input. At rock bottom right now

Sorry this is happening, but I will say as a fellow introvert, it can be difficult and sometimes the "deficiences" can be magnified by lack of being liked, or lack of being in the "in" crowd. With that said, being held up an entire year is probably useless and more likely would be better to transfer to a place you can have a clean slate than to keep on a t a program that you've had difficult with from the beginning. I can imagine that being an introvert in surgery can be rough. Is there anything else you like or is Gen surg the thing?

Additionally, clinical judgment is a pretty darn important thing - particularly in surgery where things can be life or death. An intern by about 6months should be able to handle most routine cases in terms of judgment of things. So is it medical knowledge that's lackign? difficulty making clinical decisions? wrong management? I would try to figure out what part of clinical judgement is lacking so you can improve.

If I were you, I would try to transfer or change fields.
 
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Thank you for your honesty and insight, often posts like this are "I am getting fired for no reason, should I hire a lawyer?", and only after 10 posts or so does the whole story come out.

I was told three weeks into intern year that I was behind my class and could be held back if I don’t improve.

When you're told 3 weeks into internship that you're behind, it's because you are missing very basic intern skills. We don't expect much of our interns in the first month, but it sounds like the basics like writing notes, organizing to do lists, talking with consultants and families, etc, all were lacking in your medical education. For others that may be reading this, if you get a message like this it should be a huge red flag that you're already in serious trouble.

At this point you seem to have a better sense of what your problems are, and are voicing more insight into the issues that might have gotten you to the place you're in.

Options:

1. Ask to repeat the entire PGY-1 year. You would start on July 1 with the new interns. Hopefully now you'd be able to "compete" with them -- i.e. you'd look as good as at least a middle of the road intern, hopefully better. You would then have an entire extra year to build up your skills. But it sounds like this is what they were planning, and now you've been given a warning that if you're not better in 3 months you're getting let go. I agree the chance of recovery at this point isn't good. You could meet with your PD again and try to get very specific goals of what you'd need to be able to do to move forward.

2. Think about moving to a new field. If there are programs in Anesth or ED where you are, you could explore them. Both are reasonably competitive. Surgical residents who do well clinically but don't work well in the OR often end up in anesthesia, but if your program is saying you're having trouble managing clinical issues that's going to worry both Anesth and EM programs, since that's a core part of what they do. Psych has gotten more competitive, and you'd need to ensure both for yourself and for programs that you'd really be interested in it.

If you complete the intern year and get credit for it, you would be able to get a medical license in many states. This might allow you to get better clinical experience then you'd otherwise be able to obtain. It's not clear from your description whether your program will give you full credit for the year, I worry they will not.


I think the most important thing you can do is find someone in your program who can give you very clear feedback and advice. Tell them to not fool around and just be honest with you. Are you still improving, or have you hit a plateau and not really getting any better? What field(s) do they think you might succeed in? And what fields are you actually interested in?
 
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I want to thank everyone for their input.

Part of my issues are not able to demonstrate that i can synthesize clinical facts on the spot. When asked what I want to do suddenly, I blank out often, likely because of performance anxiety, and just blurt out anything just for the sake of saying something. Under less stressful environments, I am able to work out the facts and come to a decent plan. I am currently working with a learning specialist from the school and meeting with a therapist for performance anxiety.

I have sound medical knowledge, one of the positive things they said about me, just not able to synthesize it, at least, not on the spot. My absite score was not super high but it was above national average, usually where i land with standardized tests. Basically, their main issue is I am not trusted to take care of patients on my own. I was hoping to have a year to demonstrate that all I needed was to catch up to where I should have been last july, but again, they are not letting that happen. I am going to write an apeal to the "committee" to request that my probation period be extended a year or at least 6 months so that I have more time to show improvement, at the very least to have the opportunity to become a better doctor regardless of what other field I land in. Sitting at home, falling into a world of debt, for 6 or 9 months hoping to match or transfer in another residency is not going to make me a better physician. I hope I can at least implore some compassion from them, after all, I am their resident, and they have invested a whole year on me. This is probably wishful thinking.

I entered medical school wanting to go into psych. My mentor was a psychiatrist and I worked at private psychiatric clinic for two years prior to medical school and my background is in anthropology and Buddhism. I think if I have a chance at another field, it would be psych, my first aspiration.

I know I need to prepare for the worst, but it is just so hard to know that when it comes to the OR, that is when I am told I am way ahead of my class. Everyone tells me "i have good hands" and trust me to do more right off the bat. I am just not there as a clinician, which is more important at this stage.
My program director said for these three months she wants to give me rotations where I can demonstrate clinical evaluation skills. One of them is nights. the other she left up to me ant the third will be an elective. What worries me about that is that it seems she is not incorporating me into incoming years schedule, rather treating me more like a prelim. I know everyone is saying, it doesnt look good, but it is so hard to accept because I don't want to quit, but I need to also be prepared when the talk of resignation comes up. I worked so hard to get to this point and now I find myself in this nightmare that just seems to get worse.
 
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Surgeons are confident and decisive. Whatever you chose to do you can't give it less than 100%.

Acquire all the information you need to make your decision. Talk to the people that need to be talked to.

Then either:
1) work your tail off with the goal of staying in your program even if you have to repeat a year, or
2) do everything you need to make sure you have the best application you can in for psych next cycle.
 
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It’s been a tough gen surg intern year. I was told three weeks into intern year that I was behind my class and could be held back if I don’t improve. I thought I was doing better but last January I was put on remediation. I improved on all deficiencies except clinical judgement last time I spoke with PD last month and that was why they were holding me back. I just met with her and now new deficiencies are brought up and I will be out on 3 month probation with possibility of dismissal now. I struggled with clinical skills from the beginning. My 3rd and 4th yrs in Med school were not clinically challenging bc of the type of rotations I chose . I stayed in regional campus instead of moving down to academic center. I got great surgery skills bc there were no residents, but the problem was there were no residents, no rounding, no note to be written. In hindsight it was just a lot of shadowing. It caught up with me intern year. Being behind and an introvert I also was not very liked by residents. I worked my tail off trying to improve but my clinical judgement was not there from feedback. I also did not take responsibility for my deficiencies initially and blamed it on the residents not liking me. That only made things worse. Needless to say, the program director said I was definitely going to be held back one year which I accepted and came to terms with. But I met with her today and my situation is way worse. I’m on 3 month probation and if I don’t improve they will dismiss me. Considering that I worked my tail off trying to improve up to now, I do not think I have much hope things will work out. I can make an appeal to extend my probation 6 months or 1 year but not guaranteed. I do not know how I got to this point but it really looks like they don’t want me here. If and when it comes to dismissal She will give me chance to resign so that I can apply elsewhere. I don’t know how it got so bad. A part of me still wants to believe I have a chance here, as some residents try to tell me, but reality tends to point to worse case scenario. I accepted responsibility and apologized to PD and others for not taking ownership of my deficiencies which I could not accept initially. They say that it the first step to improvement. But I have no guarantee there will be happy ending. Any advice?

What chance do I have to transfer to another residency like ER or anesthesia with these “clinical deficiency” and probation in my record. Who would accept me. Psych? Thanks for your input. At rock bottom right now

Switching from surgery to psych is relatively common. Keep your head up, those skills you’re missing are easily learned and someday you will be a great physician.
 
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Thank you. My heart is for surgery. The only instance I would go into psych or any other field is to salvage my medical career if that decision is made for me, ie they force me to resign. It was difficult enough coming to grips with being held back let alone now being kicked out. Wouldn’t wish it upon my worst enemy. My heart goes out to all those who went through similar trials. Hope you all are in a better place now. I hope someday I will be too.
 
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Surgical technical skills are relatively easy to learn. What takes time and separates the better surgeons from less talented surgeons is judgement.
Your reflection and thoughtfulness suggests to me that you have the ability to develop good surgical judgment. Try thinking of your clinical decisions the same mindful way you are changing your training habits.
 
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I want to thank everyone for their input.

Part of my issues are not able to demonstrate that i can synthesize clinical facts on the spot. When asked what I want to do suddenly, I blank out often, likely because of performance anxiety, and just blurt out anything just for the sake of saying something. Under less stressful environments, I am able to work out the facts and come to a decent plan. I am currently working with a learning specialist from the school and meeting with a therapist for performance anxiety.

I have sound medical knowledge, one of the positive things they said about me, just not able to synthesize it, at least, not on the spot. My absite score was not super high but it was above national average, usually where i land with standardized tests. Basically, their main issue is I am not trusted to take care of patients on my own. I was hoping to have a year to demonstrate that all I needed was to catch up to where I should have been last july, but again, they are not letting that happen. I am going to write an apeal to the "committee" to request that my probation period be extended a year or at least 6 months so that I have more time to show improvement, at the very least to have the opportunity to become a better doctor regardless of what other field I land in. Sitting at home, falling into a world of debt, for 6 or 9 months hoping to match or transfer in another residency is not going to make me a better physician. I hope I can at least implore some compassion from them, after all, I am their resident, and they have invested a whole year on me. This is probably wishful thinking.

I entered medical school wanting to go into psych. My mentor was a psychiatrist and I worked at private psychiatric clinic for two years prior to medical school and my background is in anthropology and Buddhism. I think if I have a chance at another field, it would be psych, my first aspiration.

I know I need to prepare for the worst, but it is just so hard to know that when it comes to the OR, that is when I am told I am way ahead of my class. Everyone tells me "i have good hands" and trust me to do more right off the bat. I am just not there as a clinician, which is more important at this stage.
My program director said for these three months she wants to give me rotations where I can demonstrate clinical evaluation skills. One of them is nights. the other she left up to me ant the third will be an elective. What worries me about that is that it seems she is not incorporating me into incoming years schedule, rather treating me more like a prelim. I know everyone is saying, it doesnt look good, but it is so hard to accept because I don't want to quit, but I need to also be prepared when the talk of resignation comes up. I worked so hard to get to this point and now I find myself in this nightmare that just seems to get worse.
When i was a Med student I had a surgery attending who said that the surgery was the easy part...a trained monkey can do surgery...the part that made you a surgeon was know what to do when a surgery goes wrong...
The ability to act and act decisively on the spot really is the test of your mettle as a surgeon...it literally is a life or death situation at times.
Hopefully you can get them to start you over as an intern, but if you don’t think that you can get yourself to the point where you can get your thought processes to the point that is needed for a surgeon, then you may want to consider switching to another specialty or surgical sub where that type of quick critical thinking isn’t as important.

And I would suggest a SICU elective as your choice.
 
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Probably not helpful, but whatever you choose, I'm rooting for you. As others have said, your insight into the current situation and the way you are evaluating options suggests to me that the building blocks are there to succeed in medicine. And if you scored above average on the ABSITE, your surgical knowledge should be adequate. Know that if it doesn't work out for you in surgery, perhaps part of the shortcoming belongs to us as surgeons for not being able to take someone who may have the tools and help them succeed.
 
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Do the best you can. Nights, maybe sicu AND sicu?

Ask to repeat intern year again, maybe even as a prelim without guarantee a pgy-2 spot.

Ask for a rec before you resign. Also see if your school have “smaller” surgical programs they are affiliated with, maybe you will fare better at a community program.

Any surgical attendings that will take your under their wings? Talk to the chief for the next year now and see if they are more understanding and get their take on the current situation?

Be more sociable, assertive and communicate better. I it can be very hard to change your “personality”. It is part of the “game” unfortunately. You have the knowledge, and skills.

To get rid of a resident, is not easy, nor terribly hard. Make sure you and PD set some kind of achievable goals.

Good luck. Keep us updated.
 
I think trying to change my current chiefs minds about me is futile. I was prideful and felt that my chiefs didnt particularly like me or treat me like they did to the other interns because I was different, older than most all of them, cared about the way I look and just wasn't as social and light hearted as my younger cohorts. In fact, the reality was that I was just a "bad" intern and i wasn't doing my part to fix it because I wasn't accepting it. I don't think they can overcome that even though I made that realization now, albeit a bit too late, maybe even for my PD. But in an attempt to prevent myself from drowning in this madness, I am reaching out to my future chiefs without any pride, as naked as I can be, and just asking for help. They have been very receptive and willing to help coach me for what is worth. In hindsight I should have done this at the very beginning with all my upper levels, but I just couldn't accept the situation and my deficiencies for what they were. It couldn't be me. It had to be everyone else that was the problem. Geez what a fool. Very painful lesson in humility.

Thanks again for all your input. I will give an update to hopefully help others who end up in this predicament as well.
 
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Switching from surgery to psych is relatively common. Keep your head up, those skills you’re missing are easily learned and someday you will be a great physician.

Since when? I'm pretty active within the national psych community and I know of no one who was dismissed from surgical residency who is a psychiatrist. Psych, especially these days, doesn't tend to take people who were dismissed for clinical judgment problems in my experience. Personalities among budding surgeons and budding psychiatrists also tend to be very different.
 
Since when? I'm pretty active within the national psych community and I know of no one who was dismissed from surgical residency who is a psychiatrist. Psych, especially these days, doesn't tend to take people who were dismissed for clinical judgment problems in my experience. Personalities among budding surgeons and budding psychiatrists also tend to be very different.
I don't think being dismissed from surgery and going into psych happens much, but the number of people who leave surgery for psych or who come into med school thinking surgery and end up doing psych is significant. I've met several.

If you are active in the national psych community then you know there is a very prominent psychiatrist who left urology residency to become a psychiatrist.

And for OP, I think someone's suggestion of offering to repeat intern year before being dismissed is a good one, I don't think i'd offer to do a prelim year with no PGY-2 guarantee. Doing that is probably better than being dismissed but I certainly wouldn't offer it up to them except maybe as a super last ditch hail mary.
 
I don't think being dismissed from surgery and going into psych happens much, but the number of people who leave surgery for psych or who come into med school thinking surgery and end up doing psych is significant. I've met several.

If you are active in the national psych community then you know there is a very prominent psychiatrist who left urology residency to become a psychiatrist.

And for OP, I think someone's suggestion of offering to repeat intern year before being dismissed is a good one, I don't think i'd offer to do a prelim year with no PGY-2 guarantee. Doing that is probably better than being dismissed but I certainly wouldn't offer it up to them except maybe as a super last ditch hail mary.

I was addressing those who are dismissed from another field. Yes, switching to psych due to a change of heart is possible and does happen. I actually know two personally who are friends of mine. But termination from one field doesn't usually equate to matching into psych, especially these days.
 
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And for OP, I think someone's suggestion of offering to repeat intern year before being dismissed is a good one, I don't think i'd offer to do a prelim year with no PGY-2 guarantee. Doing that is probably better than being dismissed but I certainly wouldn't offer it up to them except maybe as a super last ditch hail mary.

I don’t think any of the options are ideal. All of them are just different level of unpleasantness.


I was addressing those who are dismissed from another field. Yes, switching to psych due to a change of heart is possible and does happen. I actually know two personally who are friends of mine. But termination from one field doesn't usually equate to matching into psych, especially these days.

Most people don’t advertise, hey I was dismissed from surgery, now I am bailing to your field. Some of them are offered to resign with an understanding of a strong letter of recommendation is to be offered. Just food for thought.

Don’t know anyone from surgery to psych. Know of a pretty smart dude who was matched into radiology at a top school, decided to go into psych after one year. Don’t think we will ever know the “real story” other than “I’ve always been interested in psych.”
 
Most people don’t advertise, hey I was dismissed from surgery, now I am bailing to your field. Some of them are offered to resign with an understanding of a strong letter of recommendation is to be offered. Just food for thought

That's true. I guess I just can't imagine a legit strong letter being written under these circumstances. I think the OP's best option is to remediate and kick ass. If he/she is able to compete with his/her peers, then wants to leave to switch to another specialty, he/she'd have a much better chance of matching.
 
Neither can I. I just finished writing an appeal letter begging my PD and committee to grant me a repeat intern year rather than 3 month probation. If they deny it, I will know with pretty good certainty that they want me out. I was promised the option to resign rather than dismissed. Don’t know if there is too much difference with either though. If that’s the case, I prepare for the worst, take Step 3, try to find a occultation health position and keep my loans from defaulting and apply for match and also see if transfer options. My old boss is a well connected psychiatrist in Midwest and offered to help me get psych residency there. He helped a guy 10 years out of family practice get psych residency so I hope he will be able to help me, but I do not want to go into psych if I don’t have to.

If they offer me a year, I will continue to work my ass off. Halfway they if I know it’s still not going well, I will reach out to PD and work with her to try to transfer somewhere else and finish my surgery year.

Best case scenario, and far fetched, I stay with surgery and finish the dream.

That’s all I have so far.
 
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I was promised the option to resign rather than dismissed. Don’t know if there is too much difference with either though.

In terms of future prospects, this is a very important distinction. If you’re dismissed you’ll need to disclose that on future applications as well as credentialing forms - it will serve as a red flag for you going forward. If you just resign after finishing the year it isn’t reportable and you can say all parties decided to go in a different direction.

Both have the same effect (no longer being employed at the end of the year), but being dismissed is very punitive and very rare given the paperwork required and the lasting implications.
 
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Do the best you can. Nights, maybe sicu AND sicu?

Ask to repeat intern year again, maybe even as a prelim without guarantee a pgy-2 spot.

Ask for a rec before you resign. Also see if your school have “smaller” surgical programs they are affiliated with, maybe you will fare better at a community program.

Any surgical attendings that will take your under their wings? Talk to the chief for the next year now and see if they are more understanding and get their take on the current situation?

Be more sociable, assertive and communicate better. I it can be very hard to change your “personality”. It is part of the “game” unfortunately. You have the knowledge, and skills.

To get rid of a resident, is not easy, nor terribly hard. Make sure you and PD set some kind of achievable goals.

Good luck. Keep us updated.

This is just terrible advice I'm sorry. What is it with the sacrificial lamb thing here? Ask to repeat intern year? Without a guaranteed PGY-2 spot? SICU, nights? Seriously? if he is already in trouble, having more challenging rotations won't help him, and repeating the whole year is a complete waste of time and useless. And no OP should not be sacrificial lamb to ask for no guarantee of PGY-2 year. goodness! OP needs to figure out what is going wrong.
And if he is already not liked at the program, it's simply a matter of time before he gets canned. Certain deficiencies are real. Others are not. For the "soft" deficiiences, nothing OP will ever do will likely be good enough and he's wasting time.
 
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I think trying to change my current chiefs minds about me is futile. I was prideful and felt that my chiefs didnt particularly like me or treat me like they did to the other interns because I was different, older than most all of them, cared about the way I look and just wasn't as social and light hearted as my younger cohorts. In fact, the reality was that I was just a "bad" intern and i wasn't doing my part to fix it because I wasn't accepting it. I don't think they can overcome that even though I made that realization now, albeit a bit too late, maybe even for my PD. But in an attempt to prevent myself from drowning in this madness, I am reaching out to my future chiefs without any pride, as naked as I can be, and just asking for help. They have been very receptive and willing to help coach me for what is worth. In hindsight I should have done this at the very beginning with all my upper levels, but I just couldn't accept the situation and my deficiencies for what they were. It couldn't be me. It had to be everyone else that was the problem. Geez what a fool. Very painful lesson in humility.

Thanks again for all your input. I will give an update to hopefully help others who end up in this predicament as well.

Are you an IMG? You mentioned being older so not sure. If you are IMG and are dismissed that does not bode well at all.In that case I would resign.
 
Neither can I. I just finished writing an appeal letter begging my PD and committee to grant me a repeat intern year rather than 3 month probation. If they deny it, I will know with pretty good certainty that they want me out. I was promised the option to resign rather than dismissed. Don’t know if there is too much difference with either though. If that’s the case, I prepare for the worst, take Step 3, try to find a occultation health position and keep my loans from defaulting and apply for match and also see if transfer options. My old boss is a well connected psychiatrist in Midwest and offered to help me get psych residency there. He helped a guy 10 years out of family practice get psych residency so I hope he will be able to help me, but I do not want to go into psych if I don’t have to.

If they offer me a year, I will continue to work my ass off. Halfway they if I know it’s still not going well, I will reach out to PD and work with her to try to transfer somewhere else and finish my surgery year.

Best case scenario, and far fetched, I stay with surgery and finish the dream.

That’s all I have so far.

There is something off here - why are you an "old" guy? IMG? Worked elsewhere in native country before coming here?
what's the dealio? Adn I think it's a big problem that you are being told 3 months in that there is a problem. No one expects anything 3months in so the fact that they said there is a problem so soon, before even CCC committee meets if a red flag. Repeating intern year I don't think will help at a place they don't like you. If you are having this much trouble in year 1, when there are 4 other remaining years, with much more clinical judgment that will be required of you, where you'll have to be I assume on night call without much supervision and hwere you will need to supervise jr residents, this bodes poorly
 
This is just terrible advice I'm sorry. What is it with the sacrificial lamb thing here? Ask to repeat intern year? Without a guaranteed PGY-2 spot? SICU, nights? Seriously? if he is already in trouble, having more challenging rotations won't help him, and repeating the whole year is a complete waste of time and useless. And no OP should not be sacrificial lamb to ask for no guarantee of PGY-2 year. goodness! OP needs to figure out what is going wrong.
And if he is already not liked at the program, it's simply a matter of time before he gets canned. Certain deficiencies are real. Others are not. For the "soft" deficiiences, nothing OP will ever do will likely be good enough and he's wasting time.
He has no choice about nights...his PD already said that nights would be one of the 3 months while on probation...aTHREE month probation/remediation to prove himself...his PD said the 2nd rotation would be the OPs choice...and since his problem is his critical thinking skills and not his surgical skills, the sicu is a good place to develop those skills...the OP also noted that part in of his issues came from not being properly prepared while in med school where he had little experience... his salvation is not going to come from doing something easy... and for his PD to give him the choice of one of his rotations is also most likely a test as well... picking a slacker rotation is not going to look good.
The POINT of asking for a whole year instead of just 3 months gives the OP. A better chance to prove himself...even aPD made that recommendation...did you not read the posts in this thread?
 
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Not an IMG. Cultural Anthropology was my previous background. And yes it was clear from first three weeks that I was told I was at bottom of my class and could be held back. My chiefs have not thought highly of me at all although I tried to change some of their minds. I was successful in befriending one or two but not enough to turn the tide.

Unfortunately, outlook is grim. Blatantly obvious they don’t like me. I’m campaigning myself to the rest of the residents especially future chiefs. Will it make a difference. Not confident in any hope these days for good reason. Preparing for the worst. But still have to give it my all each day, out in a smile and try to get people on my side to support me. Nothing else I can do. Going back to school and going though seven years to land in this pile of **** is rough. Can’t help but feel this wasn’t meant to be
 
Not an IMG. Cultural Anthropology was my previous background. And yes it was clear from first three weeks that I was told I was at bottom of my class and could be held back. My chiefs have not thought highly of me at all although I tried to change some of their minds. I was successful in befriending one or two but not enough to turn the tide.

Unfortunately, outlook is grim. Blatantly obvious they don’t like me. I’m campaigning myself to the rest of the residents especially future chiefs. Will it make a difference. Not confident in any hope these days for good reason. Preparing for the worst. But still have to give it my all each day, out in a smile and try to get people on my side to support me. Nothing else I can do. Going back to school and going though seven years to land in this pile of **** is rough. Can’t help but feel this wasn’t meant to be

Cultural anthropology? That shouldn't matter. You obviously went through med school, so what you did for undergrad is irrelevant. I did social sciences degrees in undergrad too, that should have no relevance. Unless I missed it, how/why did med school not prepare you well for intern year? To stand out so negatively during the beginning of the year is worrisome, and to be cocky and bad is the kiss of death. Why would you be cocky? No intern should be cocky. Being clueless and even potentially bad is forgivable for most interns, but being cocky and bad pretty much means you are done. It does not really matter that much what the chiefs think - if the attendings think you are awful which is what seems to be the problem, that's what matters. I would resign if I were you. You are asking for trouble in my opinion - if you are not well liked now, months into your residency how do you think you will fare in the next many years? Just my opinion.
 
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Not an IMG. Cultural Anthropology was my previous background. And yes it was clear from first three weeks that I was told I was at bottom of my class and could be held back. My chiefs have not thought highly of me at all although I tried to change some of their minds. I was successful in befriending one or two but not enough to turn the tide.

Unfortunately, outlook is grim. Blatantly obvious they don’t like me. I’m campaigning myself to the rest of the residents especially future chiefs. Will it make a difference. Not confident in any hope these days for good reason. Preparing for the worst. But still have to give it my all each day, out in a smile and try to get people on my side to support me. Nothing else I can do. Going back to school and going though seven years to land in this pile of **** is rough. Can’t help but feel this wasn’t meant to be

Your best chance of changing impressions is stepping it up the rest of this year and the beginning of the repeated year. If that means coming in earlier so that you can round sooner and start formulating a plan, so be it. If surgery is what you want to do, put everything into it to stay. You don't need to be people's best friend, but you want them to think they can count of you as an intern.

Finding a faculty mentor that is willing to help you and speak with you honestly is good. Having an upper level or two resident, particularly one that you'll be working under during your remaining months will be helpful as well. You will need their feedback.

Good luck.
 
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For my appeal letter to extend my probation to 6 or 1 yr, my PD said to include my plans to improve: so far I have included the following:

Continue monthly meetings with PD to assess my progress or problem areas. Monthly meetings with my faculty advisor. Getting coaching from upper levels who agreed to go over clinical scenarios and past mistakes. Asking for feedback consistently from Attendings, residents and supportive staff. Possibly shadow one of my classmates for a day to see what I could be doin differently. As an extracurricular assignment, I would create PowerPoint slides on a surgery clinical decision making textbook including highlights from each chapter and creating real world examples, turn them in every month and make available as teaching resource for any resident.

Any feedback would be appreciated. Thanks
 
For my appeal letter to extend my probation to 6 or 1 yr, my PD said to include my plans to improve: so far I have included the following:

Continue monthly meetings with PD to assess my progress or problem areas. Monthly meetings with my faculty advisor. Getting coaching from upper levels who agreed to go over clinical scenarios and past mistakes. Asking for feedback consistently from Attendings, residents and supportive staff. Possibly shadow one of my classmates for a day to see what I could be doin differently. As an extracurricular assignment, I would create PowerPoint slides on a surgery clinical decision making textbook including highlights from each chapter and creating real world examples, turn them in every month and make available as teaching resource for any resident.

Any feedback would be appreciated. Thanks

I'm not sure that shadowing a classmate would be too beneficial.
 
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OP is extremely delusional at this point. Your program is interested in either two things: you resigning or being dismissed. They have no intention of keeping you. Think about it, they gave you the three hardest rotations to show improvement. When residencies fire people, they need to show they have given you ample chances to improve. If they dont, they can be open to being sued. Your program director change of heart to fire instead of remedistion means this decision is coming from above; by hospital management, etc. And they basically going through the proper motions of firing a resident (putting you on probation, etc). Your program obviously does not feel you can be a surgeon. This like a bad breakup when one person keeps trying to stay in the relationship and being delusional of the situation (mainly because they are still in love) while the other person has all intentions of leaving.
 
I’m not being delusional. I’m trying to buy a years time to stay out of debt, try to improve my evals and transfer somewhere else in better standing and even perhaps with PD help rather than them just kicking out in the street in August. If they deny my appeal, then it’s worst case scenario and go into salvage mode
 
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For my appeal letter to extend my probation to 6 or 1 yr, my PD said to include my plans to improve: so far I have included the following:

Continue monthly meetings with PD to assess my progress or problem areas. Monthly meetings with my faculty advisor. Getting coaching from upper levels who agreed to go over clinical scenarios and past mistakes. Asking for feedback consistently from Attendings, residents and supportive staff. Possibly shadow one of my classmates for a day to see what I could be doin differently. As an extracurricular assignment, I would create PowerPoint slides on a surgery clinical decision making textbook including highlights from each chapter and creating real world examples, turn them in every month and make available as teaching resource for any resident.

Any feedback would be appreciated. Thanks
The biggest...BIGGEST thing you can do is adjust the attitude...be humble! And take ownership of the problems that have gotten you to this point ....people always want to hear that you realize that there is no one or nothing to blame...and inherently people want to help...be contrite

Would say that you need to have a discussion of what are the expectations for you for the rotation...before you even start the rotation. Ideally with a check list ...weekly meetings either in person or over phone with your attending to get feedback...why you are improving on great but more importantly what still needs work...ideally this too is in writing even or all it is is an email confirming what was discussed in you weekly feedback. Ask your senior to go over your pts and plans at the end of the day or if possible before rounds...this will allow you daily chances to see if what you are thinking matches what your senior thinks ...or find A senior that is willing to do this with you...really shouldn’t take more that 15-30 mins to do this...write down the things you get wrong and the right answers ...
Don’t hesitate during rounds...but this only happens if you are prepared ahead of time...and READ...find some source that helps you by having cases presented and you have to come up with the plan.
 
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Cultural anthropology? That shouldn't matter. You obviously went through med school, so what you did for undergrad is irrelevant. I did social sciences degrees in undergrad too, that should have no relevance.

You harped on him being older, so he was trying to tell you that he is a non-traditional student who was in a different field and went back to school. So, yeah, it was relevant since you brought it up.
 
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I’m not being delusional. I’m trying to buy a years time to stay out of debt, try to improve my evals and transfer somewhere else in better standing and even perhaps with PD help rather than them just kicking out in the street in August. If they deny my appeal, then it’s worst case scenario and go into salvage mode
The best case scenario is for you to resign at the end of pgy 1 so you wont have a dismiss on your record. Typically surgery programs will write you a good letter if you intend to go into a non surgical field. I doubt they would be supporative of you going into another surgery program. You should also be trying to get into other fields besides surgery. But its so late in the pgy 1 year that you really might have to wait a year. Honestly your wasting valuable time when you could otherwise be trying to meaningfully salvage your career. I know what im saying is harsh but you have to come to terms with the stuation. Your program is trying yo get rid of you. It is what it is. Ive seen this before. At this point, you cannot turn this situation around.
 
You harped on him being older, so he was trying to tell you that he is a non-traditional student who was in a different field and went back to school. So, yeah, it was relevant since you brought it up.

Not really. I didn't "harp" on him being older, simply asked. I'm not the one who is putting him on probation at lightning speed - his program is. He seems to have been arrogant which rubbed people off, in addition to having difficulty professionally as well, so I'm trying to find out why.

And it doesn't matter how long his career in something else was - he still had to go to medical school right before residency, so his prior career has no relevance.
 
For my appeal letter to extend my probation to 6 or 1 yr, my PD said to include my plans to improve: so far I have included the following:

Continue monthly meetings with PD to assess my progress or problem areas. Monthly meetings with my faculty advisor. Getting coaching from upper levels who agreed to go over clinical scenarios and past mistakes. Asking for feedback consistently from Attendings, residents and supportive staff. Possibly shadow one of my classmates for a day to see what I could be doin differently. As an extracurricular assignment, I would create PowerPoint slides on a surgery clinical decision making textbook including highlights from each chapter and creating real world examples, turn them in every month and make available as teaching resource for any resident.

Any feedback would be appreciated. Thanks

I don't think this makes sense. I personally have never heard of someone doing probation for 6-12months. Essentially you are repeating the year if you are doing 12month "probation" - and it would annoy people - to have to have you meet with them monthly, do special things to catch up, etc. You'd be viewed as annoying, particulalry in Surgery. I would try to put all this effort elsewhere.
 
If by elsewhere you mean another field, that would be the goal but I am not in good standing right now nor do I have money to keep me afloat for a year so trying to stick around for a year to not default in loans and bills and hopefully get improved evals would be ideal. Will this happen, probably not but I have to try anyway. If I resign now or in three months only makes lose out on three months of pay. At this point it’s all about survival, have half a mill of debt and I don’t think Uncle Sam lets you file bankruptcy on him so I have to do whatever I can to survive this mess financially and then my medical career
 
Don't stay in residency just to pay the bills. Get the support of your program for switching to a nonsurgical field, and get a job while you are waiting

Agreed. Do you have family OP? It's understandable that you need to survive, but if you get dismissed it will be incredibly difficult to find a position. Resigning at least can potentially save your career. If you can tap into your family's support for the time being while you dealing with this, that would be ideal.
 
I was promised the courtesy of resigning before it came to dismissal, as had occurred with two people before me, one being a 4 th yr who transferred to IM. Another went to psych.
 
I was promised the courtesy of resigning before it came to dismissal, as had occurred with two people before me, one being a 4 th yr who transferred to IM. Another went to psych.
Family retired and on limited income. It was my goal to be able to support them eventually, not the other way around.
 
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Family retired and on limited income. It was my goal to be able to support them eventually, not the other way around.

Understood. I would thread carefully, also would start looking proactively for positions.
 
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