how common is it to get kicked out of residency?

[smq123]

tachypnea+non-arousable patient-call for help asap.

I have great sympathy for your case, however it looks like you didn't know how to prioritize. That is surprising to me as most of 4th year is spent in clerkships where you learn all these things afaik.

+1.

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[odieoh]

Thanks for correcting me. From NRMP Match data 2010, 22809 represents the total number of PGY-I. This number includes 3028 undesignated prelim positions in medicine and surgery. The denominator should then be 19781. This represents the number of MD's entering the pipeline with a reasonable expectation of completion of some program.

From ACGME 08-09, 258 residents were dismissed from core programs while 863 withdrew without a spot in the following year. Most likely, these residents are eliminated from the pipeline. This 1121 number does not include a larger number of residents who were able to transfer.

Therefore 1121/19781 = 5.67%. This is a rough estimate of the number of MD's who never finish a core residency.

The dispute is whether the dismissal or withdrawal was legitimate or illegitimate. Procedural and substantive safeguards would reduce the number of illegitimate dismissals.

Well I agree that there needs to be a change in the process to be able to terminate a resident. And certainly some of the 863 who withdrew were likely pressured into resigning with threat of termination.

That being said there are a good number of that 863 who withdrew for whatever other random reasons, health issues, pregnancy, pursuing other lines of work etc etc etc. And some of them do end up back in medicine and finish a residency, even if they have to take a couple years off in the meantime. I still feel that ~5.5% is an inflated number.

 

[Roofie]

Well I agree that there needs to be a change in the process to be able to terminate a resident. And certainly some of the 863 who withdrew were likely pressured into resigning with threat of termination.

That being said there are a good number of that 863 who withdrew for whatever other random reasons, health issues, pregnancy, pursuing other lines of work etc etc etc. And some of them do end up back in medicine and finish a residency, even if they have to take a couple years off in the meantime. I still feel that ~5.5% is an inflated number.

It is unlikely that any resident would withdraw unless he/she was influenced to do so. The resident has already finished medical school and can reasonably expect to earn 7-10 million over a 30 year career. A very small minority would turn down such an opportunity.

A resident, leaving to pursue other lines of work, is likely influenced by how he perceived he was being treated by the program. Imagine working hard, achieving par objective parameters, yet being subjectively poorly evaluated to justify a dismissal or non-renewal. On the one hand, the resident is told he is not fit to be a physician; yet on the other hand, he has achieved objectively similar outcomes to his peers.

Residency is also about making mistakes. Any MD who claims he never made a mistake in residency is deluding himself. The problem for targeted residents is that their mistakes become reasons to dismiss academically or worse to threaten their licensure. The problem then becomes whether the resident would risk his licensure to continue in a program that takes steps to document every shortcoming to justify a dismissal while not doing the same for every other resident. A deep distrust and a lack of faith in the system could become much more pernicious that an objective deficiency that could be corrected.

I have seen residents who committed malpractice and still graduate with the support of their programs, while others get dismissed over mistakes that no where come close to malpractice.

People do not withdraw for health issues. They take a leave of absence. Their spot must be secure for ADA and FMLA reasons. Any illegimate conduct that would implicate these statutes would give the resident an easier path to a wrongful termination suit.

 

[UMED122]

What types of programs are generally most protective of their residents? Academic powerhouses? Community programs? Medium sized academic programs? Located in a big city vs. not?

 

[vancouvergeorge]

It is unlikely that any resident would withdraw unless he/she was influenced to do so. The resident has already finished medical school and can reasonably expect to earn 7-10 million over a 30 year career. A very small minority would turn down such an opportunity.

A resident, leaving to pursue other lines of work, is likely influenced by how he perceived he was being treated by the program. Imagine working hard, achieving par objective parameters, yet being subjectively poorly evaluated to justify a dismissal or non-renewal. On the one hand, the resident is told he is not fit to be a physician; yet on the other hand, he has achieved objectively similar outcomes to his peers.

I know a close friend who quit a few weeks into PGY1 for a consulting gig that paid in the low six figures. He was facing the prospect of family medicine. He did his math and figured he would be better off in consulting. So anything is possible.

There are quite a few lucrative opportunities outside medicine for MDs. One would think this would draw away at least a small percentage of people.

 

[FutureInternist]

If you're just a below average resident in a run of the mill program, I don't think there's anything to worry about.

SWEET!!!!! I'm safe

 

[docbill]

SWEET!!!!! I'm safe

Me too.... but you are not safe from me. Victory is mine.

 

[dragonfly99]

I would think it's fairly unusual for a fp intern to be offered a lucrative consulting job. I'm thinking that the person must have had some sort of business background or other skills to merit that. It is probably true that some interns do leave to pursue other opportunities, however. There are people who are great with computers, have a business background, etc. For most of us, science and medicine is what we know, and we don't necessarily have a lot of other skills that would quickly translate into another kind of job. I do know of one cardiology fellow who quit to pursue other entrepreneurial stuff...I think it's kind of weird though...I mean to go to all that trouble to get through residency and get a cards fellowship and then bail. I mean, what the heck!

 

[OldPsychDoc]

...
Real life reasons for getting kicked out of residency:
1) Not showing up after repeated warnings for not showing up
2) Incompetence after several remediation attempts
3) Trying to cover up a major mistake and then failing to admit it when confronted
4) Major league insubordination (like punching an attending on more than one occasion)
5) Drug abuse after failed attempts to correct it
6) Commiting a felony

You left out:
7) stealing drugs from a patient;
and
8) having sex with a patient.

Although I suppose they're kind of covered under #5 & 6 (especially if #8 is underage and/or involuntary...)

 

[Darkskies]

SDN reasons for getting kicked out of residency:
Real life reasons for getting kicked out of residency:
1) Not showing up after repeated warnings for not showing up
2) Incompetence after several remediation attempts
3) Trying to cover up a major mistake and then failing to admit it when confronted
4) Major league insubordination (like punching an attending on more than one occasion)
5) Drug abuse after failed attempts to correct it
6) Commiting a felony

Would commenters please discuss reason number two? Especially since Winged Scapula mentioned that a lack of common sense or being clinically slow is more likely to result in termination than other reasons(despite academic competence and clinical knowledge as determined by test scores and grades).

 

[gutonc]

Would commenters please discuss reason number two? Especially since Winged Scapula mentioned that a lack of common sense or being clinically slow is more likely to result in termination than other reasons(despite academic competence and clinical knowledge as determined by test scores and grades).

Clinical/medical/scientific knowledge without the ability to apply it is useless to patients and to your career as a physician. Nobody cares if you scored 260 on your steps if you can't do a basic chest pain or GI bleed workup. On day 1 of internship, you should know to order enzymes and an EKG in the first setting and a CBC, coags and volume resus (+/- GI consult) in the second. If you can't do at least that much halfway through intern year, even with assistance from senior residents and faculty, that's what WS was talking about.

 

[Darkskies]

Clinical/medical/scientific knowledge without the ability to apply it is useless to patients and to your career as a physician. Nobody cares if you scored 260 on your steps if you can't do a basic chest pain or GI bleed workup. On day 1 of internship, you should know to order enzymes and an EKG in the first setting and a CBC, coags and volume resus (+/- GI consult) in the second. If you can't do at least that much halfway through intern year, even with assistance from senior residents and faculty, that's what WS was talking about.

I realize that that is what WS was referring to but it still doesn't exactly answer my question which is whether anyone knows how a hypothetical resident can improve if he is clinically slow, is disorganized and lacks common sense but has great scores. Would said resident be quickly singled out for termination? Can one improve on these nonacademically related skills during medical school before residency?

 

[lipomas]

I realize that that is what WS was referring to but it still doesn't exactly answer my question which is whether anyone knows how a hypothetical resident can improve if he is clinically slow, is disorganized and lacks common sense but has great scores. Would said resident be quickly singled out for termination? Can one improve on these nonacademically related skills during medical school before residency?

Generally what happens is that the deficiency is brought to the resident's attention via evaluation or meetings. At this point things probably vary - some programs probably put the onus on the resident to recognize the problem and get the appropriate help. Others provide remediation and education. Usually the problem is that the resident fails to acknowledge that there is any problem, or thinks everyone ELSE is an idiot. Then the same mistakes happen again, evaluations continue, and then termination could happen.

There seems to be a lot of paranoia on these forums that residents are somehow frequently fired for making simple honest mistakes that are never brought to their attention. This is very rare.

And yes, there are always opportunities to improve on non-academic skills during med school and residency. A lot of times it just takes initiative. Talk to others, get advice, etc. Lots of problem residents just go about their own business and don't seek out any advice or help. It may be a problem of organization, time management, it may be cultural, it may be attitude. These things can all be addressed if the resident actually commits to it.

 

[shopsteward]

Generally what happens is that the deficiency is brought to the resident's attention via evaluation or meetings. At this point things probably vary - some programs probably put the onus on the resident to recognize the problem and get the appropriate help. Others provide remediation and education. Usually the problem is that the resident fails to acknowledge that there is any problem, or thinks everyone ELSE is an idiot. Then the same mistakes happen again, evaluations continue, and then termination could happen.

This is the biggie. Sometimes it's the resident's own fault for not recognising that there is a problem, or not recognising the seriousness/urgency of the problem. But it can also be that the message didn't get through, or took too long to get through, because it was too heavily sugar-coated - it's not a pleasant thing to tell someone they are failing or at risk of failing, and it's not always easy to do it so that the message is clear but the outcome (effective remediation) is positive.

The basic thing to do, before you start, is to read your residency contract. That will set out the procedures for remediation: if you have read and understood those procedures you should be able to recognise if they are being applied to you, what you need to do to sort the problem and your likely timescale for doing it. And if there is someone in your programme who has the role of providing assistance to residents, go to them for help as soon as you know there is a problem which could land you in remediation - they can help, but will be much more effective in helping if they are involved from the start of the issue.

As to recognising problems before they get to the remediation stage, how about this: if a person in power over you has told you the same thing twice or more, and you have then shown that you haven't understood it or haven't acted on it, then you potentially have a problem. Not necessarily a problem with your work, but you do have a problem.

 

[alittlestory]

Mostly you do not get kicked out for "messing up." You get kicked out for political reasons. You piss off the senior resident, or the program director or the hospital brass. They can make you gone even if you're the best resident to trot in the door. I've seen it happen. And if it does, not really a whole lot you can do about it.

Amen to that-

The midwest program you mentioned didn't happen to be in Chicago, did it?

 

[Neuronix]

there are some sad sacks in running programs who are so screwed up themselves with a dash of viciousness in their personality that they take delight in destroying other people's lives.

Mostly you do not get kicked out for "messing up." You get kicked out for political reasons. You piss off the senior resident, or the program director or the hospital brass. They can make you gone even if you're the best resident to trot in the door. I've seen it happen. And if it does, not really a whole lot you can do about it.

i cannot remember a more ture statement than this. the clinical yrs are a function of your ability to do face time (to stay around, in the visual fields of the people that matter regardless of how late it is and of course how utterly wasteful it is of your time), suck/lick you name it (essentially all of it), appear enthusiastic and willing (to compromise your learning experience by doing scut work to please a resident who want to lighten their own load) and of course, luck. by luck i mean getting on a team or having an attending that is really good.

basically, the whole thing is a joke. i think the clinial yrs should be pass/fail only because you're either a f**k up or not. everyhting else is entirely subjective.

in fact, and quite sadly, 3rd yr is an introduction to the real world....that it's essentially all politics and that you gotta learn to paly the game.

and if you choose not to, you may not honor. life most things in life, it comes down to what you're willing to sacrifice...

I cannot agree with these two older posts more. I've been on two separate rotations where I worked hard and performed well but managed to piss someone off leading to poor evals. On the one rotation, the director wrote a one page essay about how lousy I am to the med school for no good reason. They did this to another student earlier in the year who has been described to me by three different people as a sweetheart. The med school dean threw the evaluation out and told me the person who wrote it is a loony. But what if I didn't have that protection? I'd be out of a residency and out of a career.

Oddly, both programs I've had bad experiences with are often mentioned as being great programs here on SDN. I'm disgusted. I can easily see people being fired just for not kissing ass. If someone doesn't like you, they can blow every little thing into an error. I just had a rotation experience like this. I felt like I did the right thing every time and made tiny little mistakes here and there along the way, and it's all being held against me even when I didn't make a mistake because "well I should have known that without asking a resident". I have tremendous sympathy for those who post on SDN with these types of stories.

 

[buckley]

Politics. Definitely politics.

 

[turquoiseblue]

i second that.

it's about personality clashes, even minute ones. who likes who, who sides with who..how you do or don't fit in, etc. it's not about knowledge at all or how hard you work or about a learning experience. sad but true. i've met attendings that literally want to destroy you just because they simply somehow don't like you. if you find something unfair and speak out, you are suddenly considered the bad apple of the bunch.

i know someone who was banned from a hospital simply for telling the director that the fellows weren't allowing them to do a-lines or central lines, while they allowed medical students to do that. instead of rectify it they want to ruin that resident's career. the attending found out that person told the director about the unfairness and then started badmouthing about that resident to the director. Guess who's side the director took? the attending's. the resident's words were then nothing but invisible particles moving through the air. that's just one of many examples. i guess that is called whistle blowing...i mean a career ruined over that? especially a medical career you worked so hard to get to? that is absolutely ridiculous. there should be some protection from things like that.

 

[lipomas]

Fair enough, but bear in mind that all personality clashes have two sides. There is a lot of talk on these forums about people getting bad grades because someone "doesn't like them." OK, so why don't they like you? Are there lessons you can learn to modify your behavior? You can treat these things like aberrations or you can treat them like a learning experience - perhaps there is something in your conduct or demeanor that needs to be addressed. And even if there isn't - part of being a professional and being a leader is learning how to deal with problematic people. The response can't always be to just complain.

I completely don't buy the story of being banned from a hospital just for telling someoine that fellows weren't allowing them to do lines. There is almost certainly more to it than that. Like ten minutes of succeeding arguments and name calling. Or inappropriate responses to follow-up questions.

A lot of people style themselves as some sort of hero or iconoclast for speaking out against some perceived wrong. In many of these situations, there is a major lack of observation or common sense which could have replaced the speaking out.

 

[zihuatanejo]

Fair enough, but bear in mind that all personality clashes have two sides. There is a lot of talk on these forums about people getting bad grades because someone "doesn't like them." OK, so why don't they like you? Are there lessons you can learn to modify your behavior? You can treat these things like aberrations or you can treat them like a learning experience - perhaps there is something in your conduct or demeanor that needs to be addressed. And even if there isn't - part of being a professional and being a leader is learning how to deal with problematic people. The response can't always be to just complain.

I completely don't buy the story of being banned from a hospital just for telling someoine that fellows weren't allowing them to do lines. There is almost certainly more to it than that. Like ten minutes of succeeding arguments and name calling. Or inappropriate responses to follow-up questions.

A lot of people style themselves as some sort of hero or iconoclast for speaking out against some perceived wrong. In many of these situations, there is a major lack of observation or common sense which could have replaced the speaking out.

The overall tenor of your posts on SDN are so one-sided and biased that I am starting to suspect that you are a program director or hold some sort of administrative position in a residency program. Your lack of open-mindedness would trouble me greatly if I was a candidate for your residency program. You keep insisting that it is very rare for residents to be terminated wrongfully and that over 99% of terminations are justified. Where is your evidence and data for such an assertion? There were data recently posted on SDN showing that about 1500 residents resign or are terminated annually and another 1000-1500 transfer to other programs. Are you suggesting that almost none of these residents were mistreated or harrassed or pressured to resign or terminated wrongfully? Where is your data or evidence for such an assertion? Much of what you offer here as facts or authoritative opinions are nothing more than conjectures or suppositions.

 

[Neuronix]

OK, so why don't they like you? Are there lessons you can learn to modify your behavior?

The main lesson I've learned is, if someone seems to genuinely ask you if you like everything or if there's any problems, just tell them everything is great no matter what. Also, even if you disagree with your resident, just tell them yes they are right, and either do what they say or indirectly pretend like you did what they said without harming the patient. All of my problems could have been and since have been avoided since learning those lessons.

**** flows downhill in medicine. Yell at those under you and demand they kiss your ass. Not everyone is like this, but some percentage is, and it seems obvious that this small percentage of people can ruin your grades or even residencies even if you are completely reasonable. In med school I at least had a sympathetic administration to back me up. Residents aren't so lucky.

And even if there isn't - part of being a professional and being a leader is learning how to deal with problematic people. The response can't always be to just complain.

Professional = passive-aggressive in the hospital. Don't try to solve things or give direct feedback. Those considered the best just keep a smile on and never ask questions of their seniors except in a very shy, self-condescending way.

 

[Big Question]

Hi!

I registered just so I could reply to Neuronix, as I had very similar experience in clerkships. First off, I studied, and now wait for residency in a European country, but I am puzzled by the similarities.

I spent a few weeks on a general surgery ward once. I had been advised to greet all nurses, and tiptoe my way around. Upon arriving, I pretty much made record of everyone I saw, kept a mental record of their names, but I didn't spot the head nurse. When seated with the nurses in the lounge, I asked what they expected of me as a (then) medical student. The head nurse, whom I met for the first time, gave me a lecture of how I should greet everyone. I learned that she had seen me (even though I hadn't seen her - maybe because she was passing in a rush, and insisting on greeting busy people is a high-risk game). I had just read a book on assertiveness, so I put on a smile and asked the nurse why she hadn't stopped me, if she saw me, so that I could greet her? I can't remember her reply, but I do remember being pulled aside by the director before surgery the day after, and lectured on complaints by nurses already at day 1. I decided to act assertive as much as I could, and said that I was disappointed to hear that, what was the problem? But he yelled, I don't have time, I am heading into surgery, you straighten up your act, or you are outta here. ) (man, I hate abrasive and macho ppl)

Now, fast-forward a few days, and picture the morning staff meeting, they discussed a case of not being able to determine whether the entire tumor in a cancer patient had been resected or not, due to wrongful marking of the specimen. The surgeons yelled at each other, and the pathologist stuttered a concern, as he was simultaneously trying to point out a problem, whilst also trying to avoid impeaching himself for not being able to give a proper diagnosis... What a sight.

Then, a few minutes later, they started discussing a patient case when I decided to ask if I could voice an idea. The department director quickly brushed me off. Then I didn't back off and said in a friendly tone that he asked us to contribute if we had the possibility. I continued with a workup suggestion. Another surgeon gave me a friendly nod. The head nurses which were present, and the one who had ratted me out then came back to flirt...

Anywayzzz... I could allow myself this, as I had the freedom to take my clerkships wherever I wanted, whenever.

But now residency is coming up, and what bugs me is that being assertive seems to be a dangerous strategy.

Granted, there are many ways to appear less confrontational, and more problem oriented, when asking questions when you are confronted by superiors who are ticked off by something. For instance, instead of saying: what was the problem, you can make a suggested guess, like: "was the problem that I didn't call you before I ordered the CT or should I have made a spinal tap by ophtalmoscopic exclusion only?" But even that might bee too much, and so I wonder:

Is there any way of avoiding the boot by mere chance? There will always be something you should have done differently. Even top USMLE scorers, and super-slimeball suck-ups are bound to step wrong ONCE. Now, say that you are called out for doing something you KNEW was the best thing to do, and if you just reply with "yessir, I understand sirr, I should have given the steroids before salbutamol sirrr," then you postpone a problem until next time you do it wrong again. And even worse, if the nurses smell blood, they can throw rocks in your path.

What is the optimal algorithm to maximize chances of surviving, granted there are no real deficiencies in the medicine skills department? Even if you are invisible, you might raise suspicion, or be depicted as less amicable by colleagues. Even with a shy smile, a positive face, and shutting your trap, can you be safe??? Is that the best bet?

Also, even if you disagree with your resident, just tell them yes they are right, and either do what they say or indirectly pretend like you did what they said without harming the patient.

But in case #2, what do you do next time around.... They are gonna find out you aren't doing as you are told.

OK, so why don't they like you? Are there lessons you can learn to modify your behavior?

If the problems aren't purely attributable to unforeseen chance, then yes. And I would suspect unforeseen (as in statistically impossible to foresee, not just related to the bad judgment of the resident himself) causes aren't the ones occurring most often?

I completely don't buy the story of being banned from a hospital just for telling someone that fellows weren't allowing them to do lines.

Haha, while waiting for residency, I have gotten a license to practice, and began working in an ER. I gave a student the silent treatment for a) asking me where I had studied (she was in the most prestigious school) b) looking good. c) having confidence. I know I would have hated myself as a superior, I know I acted like an a-hole, but I needed to right there and then. And never would I have admitted that in front of my boss, I would have put the blame on her, by e.g saying how she shouldn't have asked me difficult qs in front of the one with a scalp laceration.

But I made it up to her later. I saved a patient case extra for her, and helped her put in her first stitches an hour later. I do have some self-insight, I just can't control the negatives all the time.

A lot of people style themselves as some sort of hero or iconoclast for speaking out against some perceived wrong. In many of these situations, there is a major lack of observation or common sense which could have replaced the speaking out.

Very true. That holds in general for all people. Either you are completely right, and you are completely innocent, or you have the sole blame. This seems to be a thought pattern among insecure people, and they tend to go a long way to be rectified. When they are shot down by their program director, they come online to complain.

BUT: that doesn't exclude the possibility that, despite their shortcomings, they have been treated in a disgusting way. I have such a potential ****er deep inside. Just treat me miserable, and never cuddle my vanity, and it will come out. Next student.........

 

[dragonfly99]

The main lesson I've learned is, if someone seems to genuinely ask you if you like everything or if there's any problems, just tell them everything is great no matter what.]

This is probably the most important one. However, there are a few people who actually care about such things, and might try to improve the "bad" things. The problem is that we (students and residents) might not be so good at identifying those. My advice is to wait until you know someone WELL (not a few days or a couple of weeks) before venting any kind of complaint or problem that you see. Most people don't want to hear what is wrong...they are tired and busy and don't want to see or hear about problems. They just want you (the lower down person) to make things run nicely and to not hear anything bad about you.

As far as the passive-aggressive thing, I used to think that was true, but I don't think people are that way very often @my current hospital. Or perhaps I've gotten high enough that not that much **** rolls down on me any more...LOL. Or maybe I've just been socialized so that I don't notice these things any more.

 

[lipomas]

The overall tenor of your posts on SDN are so one-sided and biased that I am starting to suspect that you are a program director or hold some sort of administrative position in a residency program. Your lack of open-mindedness would trouble me greatly if I was a candidate for your residency program. You keep insisting that it is very rare for residents to be terminated wrongfully and that over 99% of terminations are justified. Where is your evidence and data for such an assertion? There were data recently posted on SDN showing that about 1500 residents resign or are terminated annually and another 1000-1500 transfer to other programs. Are you suggesting that almost none of these residents were mistreated or harrassed or pressured to resign or terminated wrongfully? Where is your data or evidence for such an assertion? Much of what you offer here as facts or authoritative opinions are nothing more than conjectures or suppositions.

Classic internet argument. I am not a program director, nor do I even work in a residency program. The hospital where I work has some residents but not in my specialty. So I guess that completely shoots down your whole argument and renders your point moot, right?

I have said several times before that I have no doubt there is resident mistreatment out there. Most of that does not lead to resignation or firing. Where is your data that most resident resignations or terminations are due to "unfairness" (whatever that means)? The offerings of most posts in this thread, other than the ones stating specific data which does not have a statistical breakdown of cause or reason, are equally filled with conjecture and supposition. Now, it is your right to presume that your conjectures are more accurate than others' conjectures, but you cannot claim this as fact. I have stated that my reason for believing this is that I know of many residents who have transferred or been dismissed or had their residency extended. None of those residents were treated unfairly overall. All these residents were given ample opportunity for remediation and the like.

Did I say "99% of terminations are justified"? I doubt it, maybe I did. That was probably a misstatement. I believe I said that most terminations were justified. But I also said that just because they were justified doesn't mean they had to happen. What I would say (and perhaps I did say earlier) is that 99% of terminations involve resident behavior and lack of insight into their own weaknesses. Because that is almost certainly true. The fantasy world being suggested here where individual hard working residents are cherry-picked out by some sleazy biased attending for "special treatment" are figments of the imagination. There are of course many program-resident combinations that just do not mesh. Some of this is because of the attitude of the program director. Some of this is because of the resident. This is the result of many transfers. But I wasn't really talking about transfers.

I note that you did not ask, nor did you consider, my thoughts on program directors. There are many crappy program directors. Many PDs have no business being in academics and having titles like "professor" because they have no desire to nor aptitude for teaching. This can also be a reason for transferring. But crappy program directors do not in and of themselves cause residents to fail residency.

 

[lipomas]

The main lesson I've learned is, if someone seems to genuinely ask you if you like everything or if there's any problems, just tell them everything is great no matter what. Also, even if you disagree with your resident, just tell them yes they are right, and either do what they say or indirectly pretend like you did what they said without harming the patient. All of my problems could have been and since have been avoided since learning those lessons.

**** flows downhill in medicine. Yell at those under you and demand they kiss your ass. Not everyone is like this, but some percentage is, and it seems obvious that this small percentage of people can ruin your grades or even residencies even if you are completely reasonable. In med school I at least had a sympathetic administration to back me up. Residents aren't so lucky.



Professional = passive-aggressive in the hospital. Don't try to solve things or give direct feedback. Those considered the best just keep a smile on and never ask questions of their seniors except in a very shy, self-condescending way.

I don't think that last statement is true at all. When I was in med school and residency the passive-aggressive were the ones who were considered to be people no one wanted to work with. They seemed less confident. Those considered the best were the ones who fit in, learned quickly, and asked appropriate questions but not excessive questions. Having a smile on your face frequently does not mean you are a kiss ass. It just means you are happy to be there. If you're not happy to be there then that's fine, but then you can't complain when people ding you for this (especially when the enthusiasm you did show was faked).

Now, everyone says that "no one likes a kissass" but that isn't really true. There are plenty of people who like kissasses. Many of them are in leadership positions in med school. Many of them are residents who are getting their first taste of power and take it too far. But these power trippers can be pretty easy to spot and get a reputation. Most people just want you to be honest, work hard, and make yourself a better doctor. I hate kissasses. They waste time. They ask questions to hear themselves talk or to make themselves seem interested.

"Disagreement" is rarely a problem if it is appropriate. There is a major difference between disagreement and confrontation. And between disagreement and passive-aggressive behavior.

My major problems in med school with evaluations were based on the old, "lack of enthusiasm" aspect. I plead guilty to that. I got graded down in three clerkships because I didn't show the proper enthusiasm that the situation apparently warranted.

 

[zihuatanejo]

Classic internet argument. I am not a program director, nor do I even work in a residency program. The hospital where I work has some residents but not in my specialty. So I guess that completely shoots down your whole argument and renders your point moot, right?

I have said several times before that I have no doubt there is resident mistreatment out there. Most of that does not lead to resignation or firing. Where is your data that most resident resignations or terminations are due to "unfairness" (whatever that means)? The offerings of most posts in this thread, other than the ones stating specific data which does not have a statistical breakdown of cause or reason, are equally filled with conjecture and supposition. Now, it is your right to presume that your conjectures are more accurate than others' conjectures, but you cannot claim this as fact. I have stated that my reason for believing this is that I know of many residents who have transferred or been dismissed or had their residency extended. None of those residents were treated unfairly overall. All these residents were given ample opportunity for remediation and the like.

Did I say "99% of terminations are justified"? I doubt it, maybe I did. That was probably a misstatement. I believe I said that most terminations were justified. But I also said that just because they were justified doesn't mean they had to happen. What I would say (and perhaps I did say earlier) is that 99% of terminations involve resident behavior and lack of insight into their own weaknesses. Because that is almost certainly true. The fantasy world being suggested here where individual hard working residents are cherry-picked out by some sleazy biased attending for "special treatment" are figments of the imagination. There are of course many program-resident combinations that just do not mesh. Some of this is because of the attitude of the program director. Some of this is because of the resident. This is the result of many transfers. But I wasn't really talking about transfers.

I note that you did not ask, nor did you consider, my thoughts on program directors. There are many crappy program directors. Many PDs have no business being in academics and having titles like "professor" because they have no desire to nor aptitude for teaching. This can also be a reason for transferring. But crappy program directors do not in and of themselves cause residents to fail residency.

I stand corrected for assuming that you were involved in an administrative role within a residency program. It seemed that way from your earlier posts regarding residents who you interacted with and who were ultimately terminated, justly in your view, from their residency programs. The thing that bothers me about your posts is the fact that you seem to generalize from a few anecdotes or experiences that you have had. You could be correct in your assertion that the vast majority of resident terminations are justified but you could also be wrong. I am genuinely curious if you have any evidence or data to back up your claims other than a few anecdotes or experiences. We are all biased by our experiences. I could also tell you many tales of residents who were mistreated and in some extreme cases terminated by their programs. I will confess that I do not know the entirety of what transpired in each of these cases. But from what I knew of these residents, they all seemed to be genuinely good individuals with solid characters. However, I did not claim, unlike yourself, that, based on these few anecdotes or experiences, the vast majority of resident terminations were either justified or not justified. For me to make such a bold claim, I would have to have intimate knowledge of what transpired in the case of each and every resident termination. Neither of us can claim to have such knowledge.

What bothers me even more is your glib tone and lack of sensitivity or compassion for residents who might have been terminated wrongfully. I do not know if you are aware of this fact, but a wrongful termination is often the equivalent of a death sentence for a medical career, especially in the case of FMGs. It does not matter how common such cases might be. One wrongful termination is one too many.

 

[zihuatanejo]

Delete double-post.

 

[lipomas]

I stand corrected for assuming that you were involved in an administrative role within a residency program. It seemed that way from your earlier posts regarding residents who you interacted with and who were ultimately terminated, justly in your view, from their residency programs. The thing that bothers me about your posts is the fact that you seem to generalize from a few anecdotes or experiences that you have had. You could be correct in your assertion that the vast majority of resident terminations are justified but you could also be wrong. I am genuinely curious if you have any evidence or data to back up your claims other than a few anecdotes or experiences. We are all biased by our experiences. I could also tell you many tales of residents who were mistreated and in some extreme cases terminated by their programs. I will confess that I do not know the entirety of what transpired in each of these cases. But from what I knew of these residents, they all seemed to be genuinely good individuals with solid characters. However, I did not claim, unlike yourself, that, based on these few anecdotes or experiences, the vast majority of resident terminations were either justified or not justified. For me to make such a bold claim, I would have to have intimate knowledge of what transpired in the case of each and every resident termination. Neither of us can claim to have such knowledge.

What bothers me even more is your glib tone and lack of sensitivity or compassion for residents who might have been terminated wrongfully. I do not know if you are aware of this fact, but a wrongful termination is often the equivalent of a death sentence for a medical career, especially in the case of FMGs. It does not matter how common such cases might be. One wrongful termination is one too many.

Well, anecdotes are important. It is also important to examine anecdotes and the source of them. I do not disagree that any wrongful termination is one too many.

I say what I posted because I have met residents who were terminated, and have listened to their stories about how "unfairly" they were treated. But many of them weren't being honest even with themselves. I saw program directors and attendings attempt to address problematic behavior, and the same things continue to happen. I have seen total lack of insight into problematic behavior, and falling back on unfounded accusations of "bias" or other conspiracy theories instead of acknowledging faults. Many of these residents were nice people who deserved success in life. But that doesn't mean they didn't make these mistakes. And being nice does not replace competency. And, to be honest, I have also improved my life and career by being called out or made aware of faults I have and seen how things can get better when they are addressed. Medical education is not just about acquiring knowledge.

I am not really coming on here to be sensitive or compassionate. That doesn't help anyone. What MIGHT help someone facing termination or discipline in residency is not to circle the wagons and "keep fighting" but to sit and think and analyze what their own faults were in getting to the point they are in now. because that can be addressed. There is no honor or glory in holding fast when your motivations are suspect or uninformed.

 

[turquoiseblue]

I am not really coming on here to be sensitive or compassionate. That doesn't help anyone. What MIGHT help someone facing termination or discipline in residency is not to circle the wagons and "keep fighting" but to sit and think and analyze what their own faults were in getting to the point they are in now. because that can be addressed. There is no honor or glory in holding fast when your motivations are suspect or uninformed.

The thing about sitting and thinking and analyzing faults is that, although it is good to do that and it helps a resident be a better resident, for the most part, it won't get you back into a program, after you have been thrown out or resigned, etc., because you are mainly only given one chance, especially if you are an IMG. Sometimes you can get back into the system but it seems that usually (although I don't have statistics to back myself up and have seen some success stories so far) it is very difficult. That's the main problem I see with residency. Rarely any second chances...even if you are willing to improve yourself.

 

[lipomas]

The thing about sitting and thinking and analyzing faults is that, although it is good to do that and it helps a resident be a better resident, for the most part, it won't get you back into a program, after you have been thrown out or resigned, etc., because you are mainly only given one chance, especially if you are an IMG. Sometimes you can get back into the system but it seems that usually (although I don't have statistics to back myself up and have seen some success stories so far) it is very difficult. That's the main problem I see with residency. Rarely any second chances...even if you are willing to improve yourself.

Well yeah, if you wait until you are about to be dismissed before you look critically at yourself, that's a problem. Is it really true that so many of you guys are on such thin ice from the get-go that one minor mistake leads you to be terminated? Because that is what you are making it sound like. You get one chance, no mistakes allowed.

Every resident I have encountered with disciplinary issues has had way way more than one chance. Whether they recognized the earlier opportunities or chances is another question, however.

 

[turquoiseblue]

Well yeah, if you wait until you are about to be dismissed before you look critically at yourself, that's a problem. Is it really true that so many of you guys are on such thin ice from the get-go that one minor mistake leads you to be terminated? Because that is what you are making it sound like. You get one chance, no mistakes allowed.

Every resident I have encountered with disciplinary issues has had way way more than one chance. Whether they recognized the earlier opportunities or chances is another question, however.

I meant getting into a second residency (a second chance at residency) is difficult. Programs do give you chances during remediation or probation, but even if you do try to improve yourself they sometimes may not see it. sometimes they don't delineate exactly what you're supposed to improve and you have to guess what you're doing wrong. or at least i had to. all they said was 'improve' or call your seniors more often. the word improve is vast and that didn't help me much...and i did call seniors more....in the end, i never knew exactly what they wanted out of me and asked and never got a straight answer. i kept getting called to the office, because my seniors would report me for this or that, even if i was doing whatever they told me, (e.g. i ordered a ct scan according to a senior and then got blamed that i gave the patient more unnecessary radiation, like it was just my fault and not my senior's too) rather than anyone tell me what im doing wrong directly....there it was always my fault, and mine alone.....i think i wasn't well liked among my collegues. they were very mean spirited toward me. i was one of 2 us born citizens.....i was singled out by all foreigners on visas who wanted to see the worst happen to me, not that i have anything against anyone for being foreign.

in my case, in the end i don't know if i was okay or not, i just left the program out of fear on my own. it was a happy day, yet i never knew i would have trouble getting residency again.