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I'm an IMG started my intern year in IM and started of with ICU rotation. I did bad not with the patient care but a bit slow due to understanding the new process and system here. But senior resident whom I rotated with made that a big issue and projected as I don't know how to take care of patients and procedures. I have to agree that I'm taking little extra time than other interns as I was worried that I would make mistake if I do it fast. Even when the workload is heavy and when try to take a breath between cases for a minute, she used to scold that I'm taking it easy and focusing on cases and I have run from a patient to patient (these are her exact words). She influenced all her batch mates that I'm doing lot of mistakes. From my side, I did couple of mistakes, one serious issue being not updated about patient condition in time as there are 6 new patients at night shift who came at the same time and first patient condition went too bad. There are too many irregularities in his lab reports which other seniors accepted and told that condition could not be avoided.
She also influenced PD and other attendings because of which my mistakes were highlighted even though other interns are making some mistakes. Even though I'm receiving positive feedback from my attendings that I'm improving, My PD now wants me to repeat my intern year based on the initial feedback and the incident mentioned above which I really don't think I deserve it. I have talked to some seniors and all were saying the same that she influenced a lot. To my worst nightmare, I rotated 2 months with her in the last 4 months and her eval has more weight as I was with most of the time.
Since there is a guy who is in prelim wanted to apply for first year categorical position, it seems like they wanted to offer him my second year position and want me to do my internship year again. Since there is only so much time left for contract renewals, I'm not sure on how to proceed. I really think I'm better than some of the interns in medical care but I have to accept my social skills are above average but not great.
Since there seems to be an alternative for them to fill my position, I don't think I will get a chance here for second year now. Is there a chance that I could apply for second year anywhere? Also think joining first year anywhere again would be hard. But doing my intern year again at this place which I clearly don't deserve to be is killing me.
I haven't received and written evals till now but my PD talked to me and asking me to apply for first year again. I'm not sure what to do at this point. Any advice is greatly appreciated.
 

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I feel like I'm missing something, you aren't even halfway into your internship and they are already asking you to repeat the year? Have you been continuing with other rotations since your very first one on the ICU?
 
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I feel like I'm missing something, you aren't even halfway into your internship and they are already asking you to repeat the year? Have you been continuing with other rotations since your very first one on the ICU?
Yes, I'm continuing my internship. My PD was saying that he needs to report to ACGME in December about the progress and the evals till now are not that good and asking me repeat my intern year. He is asking me to apply for next year again and he will offer me the first year position again.
 
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You know, I am picking up on some reasons that you're being asked to repeat intern year. It seems like you're not really on top of what's going on with your patients. I'm particularly troubled by the story that one of your patients went south and had many irregularities in his/her labs. It comes across like you weren't paying attention to those labs and missed something. Also, you say you were not updated on patient conditions because six came in on night float. To me, this sounds like you're making excuses. As an intern, you are supposed to be on the ball with your patients. You get sign outs whenever they're admitted to you and you should be on top of what is going on. Also, you're five months into intern year now, so you should be progressing with regard to efficiency and patient care. I think you need to, first and foremost, learn to stay on top of your patients and know what's going on with them. When you get sign outs, you need to pay attention to what needs to be followed, why it needs to be followed, and the plan if A or B occurs. Also, what about your knowledge base? Are you making sure you read up on your patients and their conditions? Are your inservice exam scores good?

So it sounds to me like you do need to remediate. And you need to stop making excuses. It sounds like you're trying to imply that the senior is out to screw you over rather than accept that you have deficiencies that need to be addressed. In medicine, there is no room for excuses. People's lives are at stake. You need to find out what your deficiencies are and come up with a plan to address them. And you need to make sure you read for at least an hour each day and build up your knowledge base.
 
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You know, I am picking up on some reasons that you're being asked to repeat intern year. It seems like you're not really on top of what's going on with your patients. I'm particularly troubled by the story that one of your patients went south and had many irregularities in his/her labs. It comes across like you weren't paying attention to those labs and missed something. Also, you say you were not updated on patient conditions because six came in on night float. To me, this sounds like you're making excuses. As an intern, you are supposed to be on the ball with your patients. You get sign outs whenever they're admitted to you and you should be on top of what is going on. Also, you're five months into intern year now, so you should be progressing with regard to efficiency and patient care. I think you need to, first and foremost, learn to stay on top of your patients and know what's going on with them. When you get sign outs, you need to pay attention to what needs to be followed, why it needs to be followed, and the plan if A or B occurs. Also, what about your knowledge base? Are you making sure you read up on your patients and their conditions? Are your inservice exam scores good?

So it sounds to me like you do need to remediate. And you need to stop making excuses. It sounds like you're trying to imply that the senior is out to screw you over rather than accept that you have deficiencies that need to be addressed. In medicine, there is no room for excuses. People's lives are at stake. You need to find out what your deficiencies are and come up with a plan to address them. And you need to make sure you read for at least an hour each day and build up your knowledge base.
I'm not making up excuses. Thats why I admitted that was a mistake. Regarding the lab irregularities, those were previous lab test results for which even my chief resident has no clue on what is going on and they agreed that it is just not my fault that it went south. Again, I'm not making this up as an excuse and just writing what happened. After the ICU rotation, I was constantly getting positive feedback from my other attendings that they have seen lot of improvement. Only thing I have been working and they asked me to is to speed up things. And also got the feedback from other senior residents that my mistakes were being highlighted because of her influence though all the interns are doing some or the other mistake. Regarding knowledge base, I'm definitely better than many of the interns and I have given most of the right answers for differentials when asked in a group. My inservice exam score is average.
I'm trying to remediate and working hard to prove by doing all the right things possible and getting positive feedback from some other attendings, but as I worked with other person for half of my time, they are considering her feedback.
 
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Several thoughts:
1. If your PD tells you that you need to repeat intern year, this means he's not going to give you credit to advance to second year. This means other programs are unlikely to take you as a second year either, as other programs will want your PD's input as to your abilities. Therefore, applying for PGY2 spots is not a realistic option for you. You can try, but it may be a waste of time, money and energy to do so.
2. Will your PD give you a guaranteed spot next year? Is there a chance he will change his mind? This is important, because if your PD decides NOT to give you an intern spot for next year after all, you will need to find another program. You also could choose to look for intern spots elsewhere for next year and not apply to stay at your program, but getting interviews elsewhere will be difficult given how late it is into the season and your PD may be offering you a "sure thing". If he is asking you to apply through ERAS/NRMP again, this is a positive sign he is planning to reserve an intern spot for you.
3. Will you be allowed to finish this year? If you are remediating right now, what is the chance of being let go from your program before the end of the year? If you improve, you may end up getting some credit for the rotations you perform well in, and may only have to repeat part of intern year (i.e. the rotations you haven't done well in) instead of the whole year. It is worth asking your PD about this possibility, especially if you are getting good feedback from other attendings now after a rocky start.
 
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NotAProgDirector

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To add a bit to Smurfette's great advice:

1. There should be no reason to "apply via ERAS" if they want to give you a PGY-1 spot next year. They already have your application from last year, and know you well. So they should simply be able to rank you via NRMP. You would need to register with NRMP and rank them.

2. It is very early to tell you that you're not going to be promoted. We usually make that decision in Feb-Mar. And even if we don't promote someone, we usually extend them by 3 or 6 months. So I agree that they probably want to take your prelim colleague, and simply see putting you into next year's intern class as the simplest / safest solution. But it may not be fair to you.

3. Switching programs to a new PGY-2 position is a very BAD idea. Your main problem appear to be difficulty with adjusting to new systems. Switching programs at the PGY-2 level (in internal medicine) is very hard -- you end up supervising interns and learning the system at the same time. Bad idea for you.
 
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Several thoughts:
1. If your PD tells you that you need to repeat intern year, this means he's not going to give you credit to advance to second year. This means other programs are unlikely to take you as a second year either, as other programs will want your PD's input as to your abilities. Therefore, applying for PGY2 spots is not a realistic option for you. You can try, but it may be a waste of time, money and energy to do so.
2. Will your PD give you a guaranteed spot next year? Is there a chance he will change his mind? This is important, because if your PD decides NOT to give you an intern spot for next year after all, you will need to find another program. You also could choose to look for intern spots elsewhere for next year and not apply to stay at your program, but getting interviews elsewhere will be difficult given how late it is into the season and your PD may be offering you a "sure thing". If he is asking you to apply through ERAS/NRMP again, this is a positive sign he is planning to reserve an intern spot for you.
3. Will you be allowed to finish this year? If you are remediating right now, what is the chance of being let go from your program before the end of the year? If you improve, you may end up getting some credit for the rotations you perform well in, and may only have to repeat part of intern year (i.e. the rotations you haven't done well in) instead of the whole year. It is worth asking your PD about this possibility, especially if you are getting good feedback from other attendings now after a rocky start.
Thanks for the advice. I will sure check for the possibility. PD for now, is promising that he will take me for next intern year.
 
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To add a bit to Smurfette's great advice:

1. There should be no reason to "apply via ERAS" if they want to give you a PGY-1 spot next year. They already have your application from last year, and know you well. So they should simply be able to rank you via NRMP. You would need to register with NRMP and rank them.

2. It is very early to tell you that you're not going to be promoted. We usually make that decision in Feb-Mar. And even if we don't promote someone, we usually extend them by 3 or 6 months. So I agree that they probably want to take your prelim colleague, and simply see putting you into next year's intern class as the simplest / safest solution. But it may not be fair to you.

3. Switching programs to a new PGY-2 position is a very BAD idea. Your main problem appear to be difficulty with adjusting to new systems. Switching programs at the PGY-2 level (in internal medicine) is very hard -- you end up supervising interns and learning the system at the same time. Bad idea for you.

Thank you so much for the information and advice.

My PD told me that they need to send ACGME a status report by mid December so they are informing about their decisions now. Would the rules be same for all the states as you mentioned that decision usually takes place in Feb-Mar?
Can you please explain me how the status reports to ACGME works?
For the #2 mentioned above, are there any restrictions in particular states for extending the rotations for 3 or 6 months instead of repeating for one year or the rule applies to every state? I'm asking because its only 5 months and they never mentioned this possibility.
Also wanted to check they can still take any person into 2nd year even if I'm asked to repeat 3 or 6 months? I'm not sure if they already promised him about the position,thats why I ask.
Thanks for helping me out.
 
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Thank you so much for the information and advice.

My PD told me that they need to send ACGME a status report by mid December so they are informing about their decisions now. Would the rules be same for all the states as you mentioned that decision usually takes place in Feb-Mar?
Can you please explain me how the status reports to ACGME works?
For the #2 mentioned above, are there any restrictions in particular states for extending the rotations for 3 or 6 months instead of repeating for one year or the rule applies to every state? I'm asking because its only 5 months and they never mentioned this possibility.
Also wanted to check they can still take any person into 2nd year even if I'm asked to repeat 3 or 6 months? I'm not sure if they already promised him about the position,thats why I ask.
Thanks for helping me out.

Yes, we need to complete status reports to the ACGME. We report every 6 months on the ACGME milestones. But those reports don't say whether you'll be promoted or not. They simply state where you're at.

So it's totally fine for your program to tell you that they have already decided that they are not promoting you. There's no rule about this, other than we should give you at least 90 days of notice unless that's impossible. I personally just think it's a bit crazy for them to decide now that you have no chance of improving in the next 6 months to be promoted, and that they already know that you need an entire 12 month extension. That's my opinion, but my opinion is completely useless here. They can do whatever they want. You can resign if you're unhappy with it.

There are no state rules about this. There are no ACGME rules about this. Programs can make their own decisions about how much additional time you need. And perhaps your performance is subpar enough that they have decided you really need an additional year. Or, perhaps they have decided that you will need at least an additional 6 months, and the only way they can afford to do that is to put you in a new PGY-1 slot.

They can take someone into the PGY-2 year if they want. You can't claim that PGY-2 spot. They have already declined to give it to you.

You really have little choice here. Repeat your PGY-1, or complete the year and try to find a new program to take you at the PGY-1 or PGY-2 level -- but the latter can be difficult and you might not find a spot at all.
 
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Yes, we need to complete status reports to the ACGME. We report every 6 months on the ACGME milestones. But those reports don't say whether you'll be promoted or not. They simply state where you're at.

So it's totally fine for your program to tell you that they have already decided that they are not promoting you. There's no rule about this, other than we should give you at least 90 days of notice unless that's impossible. I personally just think it's a bit crazy for them to decide now that you have no chance of improving in the next 6 months to be promoted, and that they already know that you need an entire 12 month extension. That's my opinion, but my opinion is completely useless here. They can do whatever they want. You can resign if you're unhappy with it.

There are no state rules about this. There are no ACGME rules about this. Programs can make their own decisions about how much additional time you need. And perhaps your performance is subpar enough that they have decided you really need an additional year. Or, perhaps they have decided that you will need at least an additional 6 months, and the only way they can afford to do that is to put you in a new PGY-1 slot.

They can take someone into the PGY-2 year if they want. You can't claim that PGY-2 spot. They have already declined to give it to you.

You really have little choice here. Repeat your PGY-1, or complete the year and try to find a new program to take you at the PGY-1 or PGY-2 level -- but the latter can be difficult and you might not find a spot at all.

Thank you so much for your advice, since its been only 5 months into my intern year, and now I'm receiving positive feedback, it is only fair that I will be given an opportunity to rotate for 3 additional months for the initial rotations where I was little slower than others. I can only try for that and hope for best.
 

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Be careful with the word "fair". You may think it's "only fair" that they extend you for 3 months. They might think they were very "fair" to you by not firing you in month 2 because you were so far behind. "Fair" is in the eye of the beholder. If they extend your PGY-1 for 3-6 months (for example), then they will be short a PGY-2 for 3-6 months next year. That's not "fair" to your colleagues, who will need to pick up any missed rotations.

The hard truth here is that they hold all of the cards. You can take what they offer, or try to find a better option elsewhere. If you threaten to leave unless they meet your request, they will just match a different PGY-1.
 
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Be careful with the word "fair". You may think it's "only fair" that they extend you for 3 months. They might think they were very "fair" to you by not firing you in month 2 because you were so far behind. "Fair" is in the eye of the beholder. If they extend your PGY-1 for 3-6 months (for example), then they will be short a PGY-2 for 3-6 months next year. That's not "fair" to your colleagues, who will need to pick up any missed rotations.

The hard truth here is that they hold all of the cards. You can take what they offer, or try to find a better option elsewhere. If you threaten to leave unless they meet your request, they will just match a different PGY-1.
Sure. Agree with that! I know what you mean but I didn't think that deep when I wrote that message. Thanks for letting me know and for all the help and advice.
 
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Sure. Agree with that! I know what you mean but I didn't think that deep when I wrote that message. Thanks for letting me know and for all the help and advice.

This may be part of the problem. I realize that you might be more "fast and loose" here on an anonymous chat board. But if your communication style with your program is similar to here, and you "don't think that deep" when discussing this with them, that's going to be a part of the problem.
 
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Innocent resident

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I'm an IMG started my intern year in IM and started of with ICU rotation. I did bad not with the patient care but a bit slow due to understanding the new process and system here. But senior resident whom I rotated with made that a big issue and projected as I don't know how to take care of patients and procedures. I have to agree that I'm taking little extra time than other interns as I was worried that I would make mistake if I do it fast. Even when the workload is heavy and when try to take a breath between cases for a minute, she used to scold that I'm taking it easy and focusing on cases and I have run from a patient to patient (these are her exact words). She influenced all her batch mates that I'm doing lot of mistakes. From my side, I did couple of mistakes, one serious issue being not updated about patient condition in time as there are 6 new patients at night shift who came at the same time and first patient condition went too bad. There are too many irregularities in his lab reports which other seniors accepted and told that condition could not be avoided.
She also influenced PD and other attendings because of which my mistakes were highlighted even though other interns are making some mistakes. Even though I'm receiving positive feedback from my attendings that I'm improving, My PD now wants me to repeat my intern year based on the initial feedback and the incident mentioned above which I really don't think I deserve it. I have talked to some seniors and all were saying the same that she influenced a lot. To my worst nightmare, I rotated 2 months with her in the last 4 months and her eval has more weight as I was with most of the time.
Since there is a guy who is in prelim wanted to apply for first year categorical position, it seems like they wanted to offer him my second year position and want me to do my internship year again. Since there is only so much time left for contract renewals, I'm not sure on how to proceed. I really think I'm better than some of the interns in medical care but I have to accept my social skills are above average but not great.
Since there seems to be an alternative for them to fill my position, I don't think I will get a chance here for second year now. Is there a chance that I could apply for second year anywhere? Also think joining first year anywhere again would be hard. But doing my intern year again at this place which I clearly don't deserve to be is killing me.
I haven't received and written evals till now but my PD talked to me and asking me to apply for first year again. I'm not sure what to do at this point. Any advice is greatly appreciated.
Hi there.
First of all I m very sorry about this situation.
I can understand what you are dealing with since I m in same boat with a lil difference.
My attending was very happy with me since I was the one who answered questions during the round and knows well about my pts but one of my senior seems not liking me and she reached to pd and pick my small mistakes a real big deal..
I mean I understand I have ALOT of flaws but still I m working hard man.
Any ways they extend my promotion to second year for 3 months..I also had a poor ITE score so that made the things more worse for me..
Any ways I will say accept it and suck it add long as you have a slot..there are so many who wants a slot so work hard and look forward.
Best luck
 
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Appreciate what you have, OP, which is a second chance. Another day, another year, to do what you love.
It's traumatizing what you've gone through. It is for anyone - to get so far and to realize you're not up to scratch when you've only just started - it's every intern and resident's nightmare. That journey of a 1000 steps that goes terribly, terribly wrong.

However, you're still looking at another year of medicine in the program you chose (or I assume you chose, I could be wrong) and the program still wants to keep you. Like what was mentioned above, they could have just fired you. They didn't even have to offer you a PGY1 spot. Yea it's rough, but look at it this way - people drop out during med school, or don't match, at least not straightaway. There's 'local' grads where I practice who failed or are failing intern year and are not going to get a second chance. They'll have to try their luck somewhere else, but it the failures (whether warranted or not) will follow them. Or they have to think of careers outside of clinical medicine, like research or sales for pharmaceutical companies etc.
There's nothing that says they have to keep you, it's a good sign that they do (supportive program and that you are doing well to merit another crack). It's an ultra competitive market out there now, there's like scores of grads, local or IMGs that would readily take your spot if given a chance. There's no shortage in that regard. On the other hand, if there was one really out there, then yea, you would have more power to negotiate. but not now, not in this age.

Also, I could be wrong, but just going off what you've posted, it seems that you're a bit overly focussed on attending evaluations? It's not wrong, many med students have that line of thinking. That assessment driven mind set of I must be doing fine if the attending evaluations are fine. Medicine as a resident is more than that. The attendings only see you for a minimal amount of time each day or each week when you're an intern. Majority of your time is spent with the resident supervising you, and they are also the ones directly responsible for you and the patients under your care. So, it matters a great deal what they think. Many attendings rely on the residents to help with the evaluation, some will talk to nursing staff around you too. It sucks if you don't get along with the resident supervising you, but it's also human. It will occur that you won't get along or wont' agree with someone at some point in this career. And there's a lesson in that too. Sometimes it is a game, and you have to play to succeed or survive residency. Because so much of what you do is team based, there's no I in team only ME. As an intern you're the bottom of the residency food chain (I think they said that in Grey's anatomy ha). Find ways to get along and keep the people you work with happy, if you don't, it creates tension. It benefits no one, it's bad for staff, it's bad for patients. Find out what your seniors like and find out what they don't like. You are the extension of them as their intern.

Have you thought about your colleagues too? Maybe you have, in which case, disregard what I'm saying here.
If you're unable to carry your weight, it means that work is distributed onto co-interns/residents and those directly above. They pick up the slack. It can sometimes compromise level or quality of care as resources are stretched more thin than planned and everyone's having to work a bit harder. Hospitals have ways to keep moving, there's systems in place, but someone else is doing the work if you aren't and it tarnishes your reputation in the process if they find out they're picking up the slack for you.

Finally..patients are more than just your attending evaluations. I might be trite in saying this. Apologies if I'm making an assumption here.
I've made mistakes a residents, and what haunts me more is not just that I've disappointed my team and superiors, but I've let down a patient. (I'm not senior enough thank god that it caused substantial harm, but each time I come across a similar situation I'm instantly reminded of the past).

As a resident, have awareness of what's around you and who's around you.
It's hard when something so terrible has happened, but avoid getting sucked into your own experience and trauma. Focus on your patients and work hard to redeem yourself. Never blame someone else for what's happened, just saying that as that's never what the establishment ever wants to hear. What they want to hear is admission of mistakes, that you learned from it and better yet, it's made you a better doctor.
 
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Hi there.
First of all I m very sorry about this situation.
I can understand what you are dealing with since I m in same boat with a lil difference.
My attending was very happy with me since I was the one who answered questions during the round and knows well about my pts but one of my senior seems not liking me and she reached to pd and pick my small mistakes a real big deal..
I mean I understand I have ALOT of flaws but still I m working hard man.
Any ways they extend my promotion to second year for 3 months..I also had a poor ITE score so that made the things more worse for me..
Any ways I will say accept it and suck it add long as you have a slot..there are so many who wants a slot so work hard and look forward.
Best luck
thanks!
 
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I'm an IMG started my intern year in IM and started of with ICU rotation. I did bad not with the patient care but a bit slow due to understanding the new process and system here. But senior resident whom I rotated with made that a big issue and projected as I don't know how to take care of patients and procedures. I have to agree that I'm taking little extra time than other interns as I was worried that I would make mistake if I do it fast. Even when the workload is heavy and when try to take a breath between cases for a minute, she used to scold that I'm taking it easy and focusing on cases and I have run from a patient to patient (these are her exact words). She influenced all her batch mates that I'm doing lot of mistakes. From my side, I did couple of mistakes, one serious issue being not updated about patient condition in time as there are 6 new patients at night shift who came at the same time and first patient condition went too bad. There are too many irregularities in his lab reports which other seniors accepted and told that condition could not be avoided.
She also influenced PD and other attendings because of which my mistakes were highlighted even though other interns are making some mistakes. Even though I'm receiving positive feedback from my attendings that I'm improving, My PD now wants me to repeat my intern year based on the initial feedback and the incident mentioned above which I really don't think I deserve it. I have talked to some seniors and all were saying the same that she influenced a lot. To my worst nightmare, I rotated 2 months with her in the last 4 months and her eval has more weight as I was with most of the time.
Since there is a guy who is in prelim wanted to apply for first year categorical position, it seems like they wanted to offer him my second year position and want me to do my internship year again. Since there is only so much time left for contract renewals, I'm not sure on how to proceed. I really think I'm better than some of the interns in medical care but I have to accept my social skills are above average but not great.
Since there seems to be an alternative for them to fill my position, I don't think I will get a chance here for second year now. Is there a chance that I could apply for second year anywhere? Also think joining first year anywhere again would be hard. But doing my intern year again at this place which I clearly don't deserve to be is killing me.
I haven't received and written evals till now but my PD talked to me and asking me to apply for first year again. I'm not sure what to do at this point. Any advice is greatly appreciated.
You should write a list of things you have improved at and discuss it with pd
 

Innocent resident

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Hi there I m in almost in similar situation work a lilting difference that my promotion in second year is delayed for 3 months and so add my graduation which really sucks..
1 of my senior is Tribble working with and unfortunately I had to rotate with her on one of my floor rotation, she for some reason not like me and complain to program director..long story short in addition to that I had a terrible ITE score which made the things even more complicated and here I'm on probation for 3 months
I would advice you to suck it up and keep working hard
 

Raryn

Infernal Internist / Enigmatic Endocrinologist
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Apr 25, 2008
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Hi there I m in almost in similar situation work a lilting difference that my promotion in second year is delayed for 3 months and so add my graduation which really sucks..
1 of my senior is Tribble working with and unfortunately I had to rotate with her on one of my floor rotation, she for some reason not like me and complain to program director..long story short in addition to that I had a terrible ITE score which made the things even more complicated and here I'm on probation for 3 months
I would advice you to suck it up and keep working hard
Gotta watch out for those Tribbles.

 
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Thanks for all your suggestions and support. I'm getting good reviews everywhere and even PD agreed that I don't actually deserve repeating the whole year. But since they promised another person about the spot in the second year, I still need to repeat the intern year which is kind of a pain to do it when you don't deserve that. I guess that's life for some people.
 
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