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doi726

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PD wrote me an official memo for a mistake that I made and recommended a "remediation plan." Do programs take this route in preparation for getting rid of residents?
 

Winged Scapula

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PD wrote me an official memo for a mistake that I made and recommended a "remediation plan." Do programs take this route in preparation for getting rid of residents?

Sometimes.

(sorry this is such a short answer but there is really no way of knowing what your program has planned for you; but you would be well advised to be aware that you are likely being watched and to tread lightly)
 

gutonc

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PD wrote me an official memo for a mistake that I made and recommended a "remediation plan." Do programs take this route in preparation for getting rid of residents?

Sometimes. But many programs also (and this may come as a huge shock to you and the SDN masses) use "remediation plans" to...wait for it...here it comes...remediate residents who aren't at the level of their peers at a certain point in their training (like the end of intern year).

Big picture though, you need to accept this remediation plan, put your head down and do what is expected of you (and then some) if you want to remain in your (any?) residency program.
 
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shopsteward

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You should still have a way out of this. But it certainly makes you vulnerable. My recommendations -

1. Accept that you made the mistake.

2. Make sure you understand what you did wrong that led to that mistake. This means not just accepting "I did mistake X" but also understanding "I did Y and Z which led to me making mistake X".

3. Make sure you understand the remediation plan you have been given. What do you have to do to meet the remediation? To whom do you have to prove that you have met the remediation? What evidence do you have to provide to those people which will persuade them that you have met the remediation? What is the timescale, both the final deadline and any intermediate goals? If you are unclear on any of this, talk to the relevant people to clarify it all now.

It might help you to set all this out in a table, with the answers alongside these questions, and clear it as a proposed course of action with those who will be judging you on the answers.

4. Keep track of your progress, keep talking on a regular basis to the people judging your progress, and make sure that they are kept up to date with the evidence you will be compiling that you are satisfactorily working through your remediation issues. By the time you come to the end of your remediation process you and everyone else concerned needs to be fully aware of what you have been doing, and have a neat pile of evidence of how you have met the remediation.

The short form of this is "You have an extra training course to complete in order to continue your residency. Make a plan for completing it, the way you have made plans for getting through earlier courses and exams, and then implement that plan."

If there is a resident adviser, trade union official, or similar person attached to your program who will be on your side rather than the side of the hierarchy, ask them for help.

Good luck.
 

Law2Doc

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PD wrote me an official memo for a mistake that I made and recommended a "remediation plan." Do programs take this route in preparation for getting rid of residents?

Remediation plans can serve one of two purposes, to actually get a bad but salvageable resident back on track or as a step to paper the file before firing. A lot depends on what you have done that they aren't happy about, bearing in mind that a lot of it is stuff they probably let slip by the first time or two. Unfortunately in my experience the residents asked to remediate often don't have great insight as to what they have been doing wrong, making it very hard to improve, and in a period of training where most are expected to make some mistakes it's very hard to be "on probation". But that is kind of moot -- you simply have to jump through very hoop they hold out for you, stop whatever the offending behavior was, and hope this passes.
 

Law2Doc

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You should still have a way out of this. But it certainly makes you vulnerable. My recommendations -

1. Accept that you made the mistake.

2. Make sure you understand what you did wrong that led to that mistake. This means not just accepting "I did mistake X" but also understanding "I did Y and Z which led to me making mistake X".

3. Make sure you understand the remediation plan you have been given. What do you have to do to meet the remediation? To whom do you have to prove that you have met the remediation? What evidence do you have to provide to those people which will persuade them that you have met the remediation? What is the timescale, both the final deadline and any intermediate goals? If you are unclear on any of this, talk to the relevant people to clarify it all now.

It might help you to set all this out in a table, with the answers alongside these questions, and clear it as a proposed course of action with those who will be judging you on the answers.

4. Keep track of your progress, keep talking on a regular basis to the people judging your progress, and make sure that they are kept up to date with the evidence you will be compiling that you are satisfactorily working through your remediation issues. By the time you come to the end of your remediation process you and everyone else concerned needs to be fully aware of what you have been doing, and have a neat pile of evidence of how you have met the remediation.

The short form of this is "You have an extra training course to complete in order to continue your residency. Make a plan for completing it, the way you have made plans for getting through earlier courses and exams, and then implement that plan."

If there is a resident adviser, trade union official, or similar person attached to your program who will be on your side rather than the side of the hierarchy, ask them for help.

Good luck.

I would be careful with number 3. When they formally say we need you to remediate, you have to be very very careful when trying to get them to laundry list what you need to do and for how long. The job if resident is fluid, and trying to delineate it will simply frustrate people, and add ammunition to those who are trying to say you simply "don't get it". You should try to find out what you did wrong that you can fix, and absolutely don't debate it, even if you disagree. I'm not sure you win over anyone asking about a timeframe. You have to be a better resident for the duration of your residency. make sure they give you an idea of what they need fixed, and fix it, but I'm not sure I'd try to hammer out that if you do X, Y, and Z in the next 6 months they will declare you remediated. I also never heard of a trade union official in residency, and most advisors are faculty who are beholden to the program, so don't expect anyone to stick your neck out unless you were a superstar (which is rarely the case for the folks asked to remediate).
 

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I agree with what's been said here. Put forth some extra effort to show that you've learned from your mistake and are taking steps to show it won't happen again. Offer to give a lecture or sit on a committee or something to show that you are invested in your education and the program. And own up to the mistake. Don't blame anyone else. I would also get some of these positive changes into your official file. If you had a particularly good rotation ask for a reference letter. If an attending gives you kudos for that presentation, ask to get that in writing. Unfortunately, it's easy for a program to massage the materials in your file to make it look like everything is against you.
 

Substance

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I'd record everything everyone says to you. Buy a cheap little mic recorder/mp3 player and a 16GB microSD card from Best Buy and carry it around everyday in your shirt pocket. At the end of the day, transcribe and date the conversations and save the sound files on your home computer. Save a backup in a hotmail or gmail email account, not the hospital one.

"Remediation" plans either mean that they are trying to remediate a deficiency, or they are trying to set the groundwork to can your ass. If it is the latter, having a consistent record of the interactions you had with your superiors and coworkers may be a valuable asset come lawyer time.
 

Roguelyn

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I'd record everything everyone says to you. Buy a cheap little mic recorder/mp3 player and a 16GB microSD card from Best Buy and carry it around everyday in your shirt pocket. At the end of the day, transcribe and date the conversations and save the sound files on your home computer. Save a backup in a hotmail or gmail email account, not the hospital one.

"Remediation" plans either mean that they are trying to remediate a deficiency, or they are trying to set the groundwork to can your ass. If it is the latter, having a consistent record of the interactions you had with your superiors and coworkers may be a valuable asset come lawyer time.

This is a good idea, too.
 

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This is also illegal in many states unless you have their permission to record your conversation (although it is legal in some states so long as you are part of the conversation). It may also cause HIPAA issues if you capture patient information accidentally.
 

Substance

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This is also illegal in many states unless you have their permission to record your conversation (although it is legal in some states so long as you are part of the conversation). It may also cause HIPAA issues if you capture patient information accidentally.

Good point about the patient information. That is why you should also pick up some open source sound editing software and delete the parts where patients speak from the audio files.

When transcribing the files, leave out any identifying information of patients.

The laws regarding conversation recording are different between states, so figure out whether it is legal in yours and whether you need to be part of the conversation. Nonetheless, you still should keep extremely detailed written records of all verbal communications with people.
 

mlw03

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Are you guys serious?! You think a busy resident is going to have the time/energy to edit 12 hours a day of recorded audio? Residents mess up. Learn from the mistake and move on with your career.
 

Substance

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Are you guys serious?! You think a busy resident is going to have the time/energy to edit 12 hours a day of recorded audio? Residents mess up. Learn from the mistake and move on with your career.

That's too much. Just turn on the mic when you are going to be speaking to a staff or other resident to the best of your ability. If you can't do that, email yourself a written transcript of the conversation ASAP.
 

Top Gun

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Whether they're preparing to fire you or not, its hard to tell, like everyone else has said. Depends on how benign or malignant your program is. If its benign, most likely they're trying to help you remediate a deficiency. If its malignant, they're just going through the motions of a remediation program as a step toward getting you fired.
 

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I agree with shopsteward except that I agree with law2doc about the not trying to pin them down on exactly everything you have to do to be "better/remediated". Honestly they are never going to tell you that you are in the clear although you can get off official probation - assume you're going to be watched. I would go to either a trusted faculty member (if you have one), the program director (if you have a decent relationship with him/her), or maybe the chief resident (although need to be careful because often they are beholden to people above them, IMHO tend to be yes-men and also probably have little real power) and just tell that person you are very concerned about this, want to do better, blah blah blah. This way you try to get them into your corner and get them a little invested in your succeeding. And of course you ARE going to try to do better, whether or not you agree with all the criticism you were given - some of it is probably right and we can all do/be better anyway.

Most likely they haven't decided to fire you, but they may be laying some groundwork where they could have a legal basis to do so. It doesn't mean it is inevitable or even likely to happen if you do better. Also, you can only do what you can do - if someone made up his mind to fire you and he has all the power, you probably won't be able to stop that, so worrying about it excessively won't help.

I also like the idea above about maybe offering to do some reading and/or a presentation or something, depending on what the problem/deficiency was. If it was more related to interacting with people, then think of how you can become more "zen", or if it was knowledge deficit then go study/learn about that thing, or if it was more organizational then tell your PD what your plan is to keep better track of stuff. Or if it was lack of time or laziness/getting burned out and not doing something/turfing to others then resolve to get enough sleep, get to work earlier and don't leave before other people go home.
 

NotAProgDirector

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I wanted to reinforce something mentioned above. It's unlikely that you've been given a remediation plan for a mistake. It's much more likely that you've been given a remediation plan for a pattern of mistakes, or for a pattern of marginal behavior culminating in a mistake. So, it's a "mistake" to focus on the mistake -- the problem is likely the underlying behaviors.

An example (and I'm making this up) is a resident who is sloppy with signout. Most of the time, it just annoys everyone. Then, something bad happens. The underlying problem is the sloppy signouts which need to improve, not the specific mistake which was made because of them [Again, this has NOTHING to do with the OP's issues, whatever they are. I just made that up as an example.]
 
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