Giving honest feedback about a struggling resident

[LloydInSpace]

Senior resident here.

Have been working this block with a resident who was identified to me as struggling thus far in residency, and unfortunately I have not seen any improvement in their general work-flow, knowledge base, or ward management since that time.
It is coming time for us to give feedback to the site leads and committee regarding our interns and I am very conflicted about how to approach this. Of course, the committee is aware of some of the issues, given they provided me with a heads up prior to starting, but I am unsure of how much or how detailed to be.

I really feel for this resident and think they are a lovely person, who has unfortunate personal circumstances that have lead to them having difficulties in residency.

In spite of this, I have several major concerns and would honestly say that in my eyes this intern has failed to meet the requirements to pass the rotation.
They are generally very unreliable (not doing tasks asked of them explicitly first thing in the morning), slow to round (unable to see 3-4 patients daily before we run the list), and don't implement the feedback I have been giving them throughout the block.
I have really tried to provide them with every opportunity to show growth, and given informal feedback frequently to help them see where some gaps are, as well as suggestions on what to do going forward.

For example, when reviewing a consult/admission, I will remind them to mention the absence of red flag features concerning for X diagnosis, as that is a key thing we want the listener and reader to gather when they hear the story. They nod and seem to get it. When I listen in on their review with the attending, these changes will not be made and information not added. Then the attending asks "well what about red flag diagnosis" and it's a real facepalm moment for me.
They also fail to understand (despite me saying it several times) that sick patients need to be seen first! When rounding, they have repeatedly seen our patients waiting for facility placement, and then when we run the list have told me they haven't seen the acute patients who are hypotensive and septic!!
I have taken to double rounding on their patients because I am so concerned about what may be falling through the cracks, which is leaving me short on time to do other tasks.

I have written down my feedback to help myself organize it when the time comes, but also feel guilty for having such overwhelmingly negative feedback. I know for the sake of patient safety and transparency I should bring these concerns forward, but want to give this resident every chance to be successful and improve.

Has anyone else been in a similar situation? And if so, how did you present the feedback and what did you choose to omit [if anything]?

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[DrMetal]

Senior resident here.

Have been working this block with a resident who was identified to me as struggling thus far in residency, and unfortunately I have not seen any improvement in their general work-flow, knowledge base, or ward management since that time.
It is coming time for us to give feedback to the site leads and committee regarding our interns and I am very conflicted about how to approach this. Of course, the committee is aware of some of the issues, given they provided me with a heads up prior to starting, but I am unsure of how much or how detailed to be.

I really feel for this resident and think they are a lovely person, who has unfortunate personal circumstances that have lead to them having difficulties in residency.

What specialty? A PGY1 in November? Still maybe a little new to the game, may need some time.

What kind of personal circumstances are affecting him/her? Are we talking something serious, a death in the family? Or is he just upset b/c the Lakers aren't doing well (my case).

Does he/she write things down, make a to-do list? And do it on actual paper, not on your phone. It's a crazy concept, I know, but this nugget of feedback has helped many.

 

[LloydInSpace]

What specialty? A PGY1 in November? Still maybe a little new to the game, may need some time.

What kind of personal circumstances are affecting him/her? Are we talking something serious, a death in the family? Or is he just upset b/c the Lakers aren't doing well (my case).

Does he/she write things down, make a to-do list? And do it on actual paper, not on your phone. It's a crazy concept, I know, but this nugget of feedback has helped many.

IM. And I know it’s early but we have other interns who are able to manage, even my M3s are able to do the above that I listed.
Without giving too much info, some time away from medicine due to family circumstances.
I haven’t directly suggested that, though I do see them writing down the to dos I give them on our team list

 

[DrMetal]

I haven’t directly suggested that, though I do see them writing down the to dos I give them on our team list

We're awful at remembering stuff. Maintaining a good to-do list is key.

You ever see an attending physician who doesn't writes down anything, acting like he can just remember everything because he's super smart? He's not. He just doesn't care, and nobody can call him out on it.

I would just give him your honest feedback and assessment. That's about all you can do. Fail the rotation? I don't know. It depends on what your program sets as passing/failing criteria. Not all mistakes are equal. There's a difference between forgetting to transfuse a patient that's hemodynamically unstable, vs forgetting to replete a potassium of 3.2

 

[Saddleshoes]

They are generally very unreliable (not doing tasks asked of them explicitly first thing in the morning), slow to round (unable to see 3-4 patients daily before we run the list), and don't implement the feedback I have been giving them throughout the block.

I think you have all the info you need right there!.

 

[Dral]

I think you have to just be honest with your assessment as you have outlined here. I feel by this time intern year people should have a handle on the things you mention. Being told to round on acute patients first and acting on that advice is a simple concept. Not implementing that is alarming.

I had never done icu in med school. During my prelim year I was in ICU in October. I had gotten to the point where I didn't need to carry paper notes during rounds on the floors. I thought this would translate to the ICU (over confidence). I crashed and burned my third or so day in the ICU on rounds (my senior resident was off that day). The attending took me aside afterwards and told me I had to get my butt in gear. That was such a bad day. But I quickly learned what I had to do in the ICU..vent setting, plans, what was important, how to present pts during rounds.

I suppose I righted the ship since, even as just a non-categorical, they had no issues putting me back in ICU for the week of Christmas to NYE when we all got put random places for coverage (much to my chagrin hah).

The point is that even as prelim, I underperformed at the beginning of that rotation. I wasn't even really told too much what to do to improve, just to do so, and I figured out (I suppose with my senior resident's help, don't remember entirely) what I had to do to improve my performance to a better place, and more importantly to a place that ensured patient safety.

It doesn't sound like this resident is doing that even with specific instructions. I'm not in IM, but that seems like a red flag to me. I think prioritizing patient acuity is something we learn in med school or the first month of intern year...not something we struggle with in month 5. That makes me worry that these basic concepts may be missed if this person graduates to independent patient care.

 

[thumbz]

Teaching attending here.

Be honest in your feedback to the site lead/committee. They're probably already more than aware, and your attending is very likely going to be honest as well.

It sounds like this resident needs some pretty significant remediation given what you have laid out. Trying to sugar coat how they're doing is only going to kick the can down the road. I would not expect that come January 1 they'll suddenly become a superstar, and if they do then they wouldn't end up in remediation anyways.

And don't worry about whether you feel you're being unreasonable in your expectations. If I had a senior resident come to me and say "I'm concerned about my intern, they have no idea how to manage necrotizing fasciitis" I would look at it as probably something they haven't seen before and the natural part of learning in intern year (and I would make the senior feel heard and that we would keep an eye on their concerns to make sure it isn't a pattern of medical knowledge gaps). If you came to me and said "I'm concerned about my intern, they're still not entering orders, calling consultants or following up on tasks" that's a major red flag for a clinical deficiency. Your site leads/committee/attendings have seen hundreds of residents over the years and know what is and isn't a reasonable expectation.

 

[mvenus929]

As someone who has had to develop plans for remediation for residents in the past, the more specific information you can give, the better. "I gave this feedback on this day, and the next day, they made the same mistake repeatedly" type thing.

Agree that the administration is likely very aware of the struggles of this resident--it very rarely comes out of no where and they probably already have their eyes on the resident. Just be honest.

 

[NotAProgDirector]

I think that you should avoid the language of "pass" or "fail". This is a job, it's not school and these words don't have much meaning nor will they help the intern whom is struggling. Just describe what you saw / experienced. The program will decide what's the next step, and you shouldn't feel guilty about it no matter what it is.

It's not clear from your post whether this block is coming to an end, or this is mid feedback. If it's the middle, then another question is "what can I do differently to help this person?". Doing the same thing is certain to fail -- you've seen no improvement so far. I can imagine how frustrated you are -- and if you let those types of emotions come into this process it will only spiral further into doom.

The thing that you (or someone) could do in this circumstance that might be very helpful is buddy/shadow. If you can, come in at the same time as your intern and watch them preround. Make them tell you why they are doing things / choosing whom to see / etc. Sometimes this makes it very clear what the problem is.

You also haven't mentioned the intern's insight into this. Do they understand they are in the process of failing out of the program? Because that's what's going to happen here, real soon.

 

[akwho]

Agree with the honest feedback. If they don't improve now as an intern the senior resident years are only going to be more dangerous for patients and more stressful for co-workers. I think we've all seen residents promoted who should have been remediated and it almost always causes more work/stress in the end rather than just remediating them as an intern.

 

[LucidSplash]

Different specialty but I once had a rotation where I was the senior to a team of interns and some NPs. Interns were struggling, one more than others but all were having some issues. I started doing PM non-attending rounds in addition to am pre-rounds as a team. In the PM we worked on their patient presentations and details that they needed to pay attention to/look for. Honestly is was a bit grueling on everyone. But by the end of the week the interns doing better and I was no longer getting gruff from the attending for unprepared team on am attending rounds.

 

[NotAProgDirector]

More detail on why I mentioned that I don't find the pass/fail language helpful:

If there are 12 month long blocks and an intern "passes" 11 and fails one, they will commonly assume they just need to make up that one block and then they are "good to go" for a PGY-2 year. That's the way school works -- if you fail a course you retake it, pass it, and move on. But residency is totally different. Just "passing" 12 months of intern year doesn't mean you get to be a PGY-2. You need to show a specific level of successful overall performance to warrant promotion. An intern can "pass" all rotations and still not get promoted. Or, an intern could have a miserable performance on their first month, then make dramatic improvements and get promoted right on time. Plus, it puts evaluators in a tough spot -- deciding a boolean choice where the consequences seem dire.

My 2 cents, certainly some programs will differ.

 

[calvinhobbes]

Please don’t ruin this resident’s life. Be honest with him or her but don’t tell the higher ups all negative things, it’s honestly not worth it.

 

[rokshana]

Please don’t ruin this resident’s life. Be honest with him or her but don’t tell the higher ups all negative things, it’s honestly not worth it.

Guarantee to get resident on the path of non renewal.

 

[j4pac]

I’ll add a few things to the previous advice. Only add your OWN personal experiences. Don’t include the experiences of others. They are responsible for accurately painting the picture of their own experiences.

You may be dealing with a co-resident with psychosocial factors playing a role. When a young resident is burned out, it will impact their ability to function in all aspects of life, including organization and retention. I’d talk to the resident. This is incredibly important not just for the sake of your co-resident, but something important to your own development as a physician. You can lay out a perfect plan helping the person become more organized, but if you miss that they are depressed/burnt out…then you’ve missed this. Frankly, medical professionals typically have horrible insight or will minimize their own psych issues. So if you know there are “family issues”, I can just about guarantee that’s the tip of the iceberg. Remember that this resident made it through Med school, they should have baseline competency…often a regression is due to factors such as these. This is honestly probably one of the most important things that I’ve learned in my career and has helped me with my own self preservation, helping colleagues, and my patients. We have a tendency to jump to “not being good enough” as the reason, when that’s often not the case.

I’d also recommend recommending organization strategies. We’ve all been tired, exhausted…and it’s at those times we have to rely more on structure, organization, and help.

 

[NotAProgDirector]

Please don’t ruin this resident’s life. Be honest with him or her but don’t tell the higher ups all negative things, it’s honestly not worth it.

Guarantee to get resident on the path of non renewal.

One of the worst things that can happen to a resident is to be promoted when they are not ready. if I extend training at a current PGY level, then they have more time to address their issues. If people are not honest and they get promoted, and then struggle at the new level because they are not ready, there's no going back. At that point, I'm stuck terminating them if they can't do the job. Reporting what you have experienced might get the resident on the path of non renewal. But not reporting it can be just as bad.

I’ll add a few things to the previous advice. Only add your OWN personal experiences. Don’t include the experiences of others. They are responsible for accurately painting the picture of their own experiences.

You may be dealing with a co-resident with psychosocial factors playing a role. When a young resident is burned out, it will impact their ability to function in all aspects of life, including organization and retention. I’d talk to the resident. This is incredibly important not just for the sake of your co-resident, but something important to your own development as a physician. You can lay out a perfect plan helping the person become more organized, but if you miss that they are depressed/burnt out…then you’ve missed this. Frankly, medical professionals typically have horrible insight or will minimize their own psych issues. So if you know there are “family issues”, I can just about guarantee that’s the tip of the iceberg. Remember that this resident made it through Med school, they should have baseline competency…often a regression is due to factors such as these. This is honestly probably one of the most important things that I’ve learned in my career and has helped me with my own self preservation, helping colleagues, and my patients. We have a tendency to jump to “not being good enough” as the reason, when that’s often not the case.

I’d also recommend recommending organization strategies. We’ve all been tired, exhausted…and it’s at those times we have to rely more on structure, organization, and help.

I totally agree with this in general, although I caution co-residents from trying to delve into their colleague's mental health status. If you want to say "I'm a bit worried that you may be depressed, you should consider being evaluated for that" -- that's fine. But you should not try to delve into this yourself. It's tempting to do so -- you often do with your patients. But a colleague isn't a patient.

 

[j4pac]

One of the worst things that can happen to a resident is to be promoted when they are not ready. if I extend training at a current PGY level, then they have more time to address their issues. If people are not honest and they get promoted, and then struggle at the new level because they are not ready, there's no going back. At that point, I'm stuck terminating them if they can't do the job. Reporting what you have experienced might get the resident on the path of non renewal. But not reporting it can be just as bad.

I totally agree with this in general, although I caution co-residents from trying to delve into their colleague's mental health status. If you want to say "I'm a bit worried that you may be depressed, you should consider being evaluated for that" -- that's fine. But you should not try to delve into this yourself. It's tempting to do so -- you often do with your patients. But a colleague isn't a patient.

Thanks for clarifying for me. Yeah…don’t pretend to be a psychologist. Don’t get into details…just appreciate that’s it’s likely a factor and care.

 

[shaggybill]

You may be dealing with a co-resident with psychosocial factors playing a role. When a young resident is burned out, it will impact their ability to function in all aspects of life, including organization and retention.

but if you miss that they are depressed/burnt out…then you’ve missed this. Frankly, medical professionals typically have horrible insight or will minimize their own psych issues.

This x 100.

 

[Gastrapathy]

First some feedback for you 😉: It’s too early to count on interns regardless of how good you think they are.

For the struggling intern, this makes your job much harder but you may be the only person who can save them. Don’t worry about the eval yet, focus on the feedback. You have a good list of deficiencies. Start by giving them the specific order to see the patients. Be really direct. Don’t assume they know which patients are sick. Good luck!

 

[Iamnew2]

Please don’t ruin this resident’s life. Be honest with him or her but don’t tell the higher ups all negative things, it’s honestly not worth it.

I agree with this. Don't ruin this resident's life - particularly if they are having a rough time in a personal situation. Life can sometimes be hard - harder for some than others - I remember for example that I developed a hemorrhaging tumor in my neck during residency (caused by the radiation from residency!!) and this issue consumed my every waking thought, had to see a bunch of doctors, specialists, ending up getting surgery at Mass General because the issue was so freaking rare,, ended up having thyroid issues for months, feeling exhausted and foggy brained - luckily I switched fields regardless but the whole thing was a crap show. Just because someone might be having a hard time in one area at one time, particularly so early in the year, doesn't mean that their whole career should be shot down. You can make or break this person - don't break them - it will just make their personal situation even worse. Perhaps if they are truly struggling in a personal area, they need to take some time away.

Residents are people too. Perhaps their life circumstances are more than they can bear with a demanding PGY-1 year - I would be cautious. Like PDPRogDirector said don't use the word pass or fail. You are also a resident and not really in a position where you should be making those decisions on other residents. I would always hate when senior residents felt that they had control over junior residents' lives - it just adds to the toxic culture of medicine in general.

I would pull the resident aside and have an honest conversation with them about your concerns and what you think they are not doing well.
This is just the beginning for them - there is a lot of improvement and time for them to still make a great physician.

 

[Mass Effect]

Please don’t ruin this resident’s life. Be honest with him or her but don’t tell the higher ups all negative things, it’s honestly not worth it.

I agree with this. Don't ruin this resident's life - particularly if they are having a rough time in a personal situation. Life can sometimes be hard - harder for some than others - I remember for example that I developed a hemorrhaging tumor in my neck during residency (caused by the radiation from residency!!) and this issue consumed my every waking thought, had to see a bunch of doctors, specialists, ending up getting surgery at Mass General because the issue was so freaking rare,, ended up having thyroid issues for months, feeling exhausted and foggy brained - luckily I switched fields regardless but the whole thing was a crap show. Just because someone might be having a hard time in one area at one time, particularly so early in the year, doesn't mean that their whole career should be shot down. You can make or break this person - don't break them - it will just make their personal situation even worse. Perhaps if they are truly struggling in a personal area, they need to take some time away.

Residents are people too. Perhaps their life circumstances are more than they can bear with a demanding PGY-1 year - I would be cautious. Like PDPRogDirector said don't use the word pass or fail. You are also a resident and not really in a position where you should be making those decisions on other residents. I would always hate when senior residents felt that they had control over junior residents' lives - it just adds to the toxic culture of medicine in general.

I would pull the resident aside and have an honest conversation with them about your concerns and what you think they are not doing well.
This is just the beginning for them - there is a lot of improvement and time for them to still make a great physician.

The #1 way to ruin a resident's life is by NOT telling their program leadership how much they're struggling. Covering for this resident will ruin their life, whereas telling the truth allows the program to help them, even if that means remediation. It also has the advantage of actually, you know, protecting patients.

 

[Iamnew2]

The #1 way to ruin a resident's life is by NOT telling their program leadership how much they're struggling. Covering for this resident will ruin their life, whereas telling the truth allows the program to help them, even if that means remediation. It also has the advantage of actually, you know, protecting patients.

Depends what the issues are and issues are sometimes temporary. I literally kid you not, had to talk to my advisor in residency because my pants were - wrinkled! A nurse complained that my pants were wrinkled. I had another complaint that I didn't look *excited* enough in a rotation. Really?
It's also super early in the year - not even 6months and this resident is clearly having issues. That resident is not unsalvageable. Getting a remediation or probation on their record destroys their career. Much better to take time off, regroup and then come back. Residents are people too.

 

[Warped Apostle]

Thank you for posting. First let me commend you for your patience and empathy towards this individual. The act of you seeking guidance on this matter, lets me assume that you really do care for this person and will be a great doctor. I wanted to comment because frankly I was this intern. I struggled during intern year and I can imagine my senior residents saying the similar things. Full disclosure, I ended up being placed on resident probation and ended up switching specialties. But have had a lot of time to reflect on the situation.

My first error was picking a specialty that didn't compliment my values and strengths, so I was behind from the get go. This person may also be in this situation. Plus once you are in, it is really hard to change or admit you were wrong. As for the job itself, I believe the biggest disconnect was communication. You may have felt like you were explicit in conveying feedback, but it was not interpreted that way. It's not necessarily the receiver ignoring you, but rather understanding. One way to discuss this is to understand their thought process. It's important to do this in a non-judgmental and supportive way. This might give you more insight into how to better approach or address the issues. I have never really believed in the "they just don't get it" excuse, especially with such intelligent, talented, and driven individuals.

Being a "trouble resident" can be a self-fulfilling prophecy in that you are under a microscope which can result in more errors. For example, I felt like anxious and in a constant fight or flight state. This made it almost impossible to calmly pay attention to details that are important in clinical patient care. I understand this may be more than a busy senior resident is capable of providing and encourage you to lean on your program director to provide this if they are reasonable.

 

[Mass Effect]

Depends what the issues are and issues are sometimes temporary.

We know what the issues are. Did you read the OP?

I literally kid you not, had to talk to my advisor in residency because my pants were - wrinkled! A nurse complained that my pants were wrinkled. I had another complaint that I didn't look *excited* enough in a rotation. Really?

That isn't the case here. Again, did you read the OP?

It's also super early in the year - not even 6months and this resident is clearly having issues. That resident is not unsalvageable. Getting a remediation or probation on their record destroys their career. Much better to take time off, regroup and then come back. Residents are people too.

It does not destroy their career. What are you talking about? The resident is not performing up to par. Covering that up is not doing anyone any favors. It's just allowing for the dig of an even bigger hole. Give an honest evaluation, whatever that may be and allow the program to decide next steps. If it happens to be remediation, it's much better to do it in November of intern year than in July of PGY 2 year.

 

[mvenus929]

I agree with this. Don't ruin this resident's life - particularly if they are having a rough time in a personal situation. Life can sometimes be hard - harder for some than others - I remember for example that I developed a hemorrhaging tumor in my neck during residency (caused by the radiation from residency!!) and this issue consumed my every waking thought, had to see a bunch of doctors, specialists, ending up getting surgery at Mass General because the issue was so freaking rare,, ended up having thyroid issues for months, feeling exhausted and foggy brained - luckily I switched fields regardless but the whole thing was a crap show. Just because someone might be having a hard time in one area at one time, particularly so early in the year, doesn't mean that their whole career should be shot down. You can make or break this person - don't break them - it will just make their personal situation even worse. Perhaps if they are truly struggling in a personal area, they need to take some time away.

The senior resident isn't going to make any decisions about whether the intern advances or not. Bringing up these issues can help the program support the resident and get the help they need to be successful in residency.

Depends what the issues are and issues are sometimes temporary. I literally kid you not, had to talk to my advisor in residency because my pants were - wrinkled! A nurse complained that my pants were wrinkled. I had another complaint that I didn't look *excited* enough in a rotation. Really?
It's also super early in the year - not even 6months and this resident is clearly having issues. That resident is not unsalvageable. Getting a remediation or probation on their record destroys their career. Much better to take time off, regroup and then come back. Residents are people too.

As stated above, the complaints against you are not similar to the concerns the OP has for this intern. And depending on the way things are run in the program, extra help doesn't necessarily mean a mark on the permanent record. We had multiple residents under remediation at various points during my chief year, and only 1-2 were formally on probation. We told residents early on that if they were able to complete a remediation program successfully, it wouldn't go on their permanent record, but if they were not, we'd have to advance to probation.

No one is saying the resident is unsalvageable--we're saying the resident needs more help. Maybe they can't be helped, but it's too early for that, and there's only so much support a senior resident can give before the program needs to know about those struggles.

And if the resident is as bad a OP says they are, the attending is also hopefully speaking with program leadership (though I've known attendings who will sweep issues under the rug and 'pass' a resident because they don't want the resident back on their service, so not perfect).

 

[Smurfette]

Giving honest feedback does not equal ruining a resident's life. No one is going to base any decisions based on one person's feedback. I would assume the resident is already on their radar. If not, they are going to look to see if others have noted similar trends. Since residents rotate and work with different people regularly, it is easy to pass them through but then at some point, it becomes clear they are not ok to be promoted, yet no one gave them the proper opportunity to fix it. The longer it takes to say something, the bigger the gap they have to make up. It's hard to get problems fixed and provide helpful feedback unless it can be focused for the resident with regard to what to work on, and they also have to make sure this isn't a situation where one person isn't giving another a fair shot.

For example, I recently had a student who was struggling. I had to talk to the clerkship director and I reviewed my concerns. He was able to hear my concerns and say "it sounds like everything stems from a difficulty with ___. That's sort of the central theme here. I can work with someone in the Dean's office to get her a mentor who is strong in this area to help build her skill set". I hadn't thought about it that way, but he was absolutely correct in identifying a theme. I'd been trying to give her tips on this and that and it just wasn't working. But his ability to identify this could allow her to focus her energy in a way that could fix several issues, instead of having a list of 5 things she had to individually work on and fix. While this may not translate to every struggling trainee, it does seem less overwhelming to know that fixing one problem/theme will help you in multiple ways, instead of feeling like you have an insurmountable list of problems to correct.

 

[hmockingbird]

I’m with the others. I would just be honest with specifics like what you have here. Actually I think your post as written is fine, it’s factual and not bringing your emotions into it.

If this is mid-rotation feedback/you still have time with the intern, my suggestions would be:
-Be ON them. They haven’t earned independence yet so need to discuss their plan for prerounding and have it approved by you, they need frequent check ins on tasks and approval of their priorities for said tasks, etc.
-Rope in your attending re: what you have done so far and see if they have suggestions. I think it’s awesome that you’ve tried giving so much feedback! I also recommend this to CYA as a senior.
-Consider having a big come to Jesus talk, but they may already have gotten or be getting this so not sure if it would help.

But if it’s the end of the rotation it feels like you have put a lot of effort into helping them so I would just try to give factual feedback and know you tried.

 

[hallowmann]

First some feedback for you 😉: It’s too early to count on interns regardless of how good you think they are.

For the struggling intern, this makes your job much harder but you may be the only person who can save them. Don’t worry about the eval yet, focus on the feedback. You have a good list of deficiencies. Start by giving them the specific order to see the patients. Be really direct. Don’t assume they know which patients are sick. Good luck!

I swear I have the same conversation with the categorical 2nd and 3rd years EVERY year for the last 4 yrs. For whatever reason they seem to forget how much they sucked as interns or how much they've learned to get to where they are, and it's exacerbated by the fact that they're seniors and are actually responsible for what the interns do now.

They always bring up all these things about the interns that are struggling, sometimes only 3 months in, and even last week it happened again and we're not even 6 mos in. Then I proceed to remind them that we're not 6 mos in, multiple people in their classes had similar issues and all caught up, and I remind them that sometimes it takes a bit of time to get used to the process. It's actually insane how much of a difference intern year makes almost across the board for all the residents I've worked with.

OP, my main advice would be to maintain perspective, recognize that it's early and that some people need to be told something multiple times or see it implemented multiple times before it sticks. I'd also recommend identifying things that they do well, not just their shortcomings, both for your own perspective and for them. When you evaluate them with leadership, do it holistically, don't just list off their mistakes. Sometimes we have a tendency to overlook things people do right or well, because it's the things that they do wrong that creates the biggest burden for us and stands out.

 

[Iamnew2]

The senior resident isn't going to make any decisions about whether the intern advances or not. Bringing up these issues can help the program support the resident and get the help they need to be successful in residency.



As stated above, the complaints against you are not similar to the concerns the OP has for this intern. And depending on the way things are run in the program, extra help doesn't necessarily mean a mark on the permanent record. We had multiple residents under remediation at various points during my chief year, and only 1-2 were formally on probation. We told residents early on that if they were able to complete a remediation program successfully, it wouldn't go on their permanent record, but if they were not, we'd have to advance to probation.

No one is saying the resident is unsalvageable--we're saying the resident needs more help. Maybe they can't be helped, but it's too early for that, and there's only so much support a senior resident can give before the program needs to know about those struggles.

And if the resident is as bad a OP says they are, the attending is also hopefully speaking with program leadership (though I've known attendings who will sweep issues under the rug and 'pass' a resident because they don't want the resident back on their service, so not perfect).

I respect your view point. I think it's way too early to start talking about a remediation for someone who hasn't even been at a new position for 6months and who is having a family/personal issue.

I swear I have the same conversation with the categorical 2nd and 3rd years EVERY year for the last 4 yrs. For whatever reason they seem to forget how much they sucked as interns or how much they've learned to get to where they are, and it's exacerbated by the fact that they're seniors and are actually responsible for what the interns do now.

They always bring up all these things about the interns that are struggling, sometimes only 3 months in, and even last week it happened again and we're not even 6 mos in. Then I proceed to remind them that we're not 6 mos in, multiple people in their classes had similar issues and all caught up, and I remind them that sometimes it takes a bit of time to get used to the process. It's actually insane how much of a difference intern year makes almost across the board for all the residents I've worked with.

OP, my main advice would be to maintain perspective, recognize that it's early and that some people need to be told something multiple times or see it implemented multiple times before it sticks. I'd also recommend identifying things that they do well, not just their shortcomings, both for your own perspective and for them. When you evaluate them with leadership, do it holistically, don't just list off their mistakes. Sometimes we have a tendency to overlook things people do right or well, because it's the things that they do wrong that creates the biggest burden for us and stands out.

Precisely, thank you. This is a well balanced and absolutely spot on advice. You are 100% right that senior residents don't recall how awful they were as interns. We all pretty much suck at interns initially and most people have slower starts than others. Thank you for bringing good perspective into this.

 

[IlDestriero]

You have an obligation to give honest feedback on this intern. If they are not meeting expectations AND not learning from their mistakes that’s a huge red flag that needs to be addressed formally sooner rather than later. Just because someone graduated from medical school doesn’t mean that they should be a practicing physician. I was in a super competitive transitional internship and one of my intern colleagues was like this person, maybe worse. He was good on paper and horrible as a physician. They extended his internship, but ultimately threw him out. He, for whatever reason, didn’t have the skills, insight, and work ethic to be a physician.
That’s not your fault. They’re almost 1/2 way through internship and they’re making 1st week mistakes and not learning from feedback. You can’t keep kicking that can down the road. Leadership needs these honest assessments and they will determine how to move forward and what the intern needs. Double secret probation is real.

 

[ortnakas]

Better to remediate an intern when there’s still a chance then release a graduated resident you’re not willing to write a letter of LOR for and may be liable to kill somebody.

Knowledge gaps will fill in (and we all had them as interns so don’t fall into the trap of judging your interns for them when you’re a senior, or an attending) but work flow/work ethic gaps and not being receptive to feedback are more problematic. Make sure that the personal/mental health issues aren’t the core of the issue.

There has to be a way to remediate somebody without being an a$$hole to them. Pity neither medical school or GME has found a way to do so yet.

 

[j4pac]

Giving honest feedback does not equal ruining a resident's life. No one is going to base any decisions based on one person's feedback. I would assume the resident is already on their radar. If not, they are going to look to see if others have noted similar trends. Since residents rotate and work with different people regularly, it is easy to pass them through but then at some point, it becomes clear they are not ok to be promoted, yet no one gave them the proper opportunity to fix it. The longer it takes to say something, the bigger the gap they have to make up. It's hard to get problems fixed and provide helpful feedback unless it can be focused for the resident with regard to what to work on, and they also have to make sure this isn't a situation where one person isn't giving another a fair shot.

For example, I recently had a student who was struggling. I had to talk to the clerkship director and I reviewed my concerns. He was able to hear my concerns and say "it sounds like everything stems from a difficulty with ___. That's sort of the central theme here. I can work with someone in the Dean's office to get her a mentor who is strong in this area to help build her skill set". I hadn't thought about it that way, but he was absolutely correct in identifying a theme. I'd been trying to give her tips on this and that and it just wasn't working. But his ability to identify this could allow her to focus her energy in a way that could fix several issues, instead of having a list of 5 things she had to individually work on and fix. While this may not translate to every struggling trainee, it does seem less overwhelming to know that fixing one problem/theme will help you in multiple ways, instead of feeling like you have an insurmountable list of problems to correct.

It sounds like you have an exceptional clerkship director.