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How does one fail a rotation?

Discussion in 'General Residency Issues' started by doctorpurple, Aug 6, 2015.

  1. doctorpurple

    5+ Year Member

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    Hi I'm a new intern and on my second rotation. I felt that first rotation was difficult and the learning curve was steep. I'm worried now with all these threads talking about non-renewal. How does one find out if they fail a rotation? No one has communicated anything yet to me about this at my program.
     
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  3. Doctor Bagel

    Doctor Bagel so cheap and juicy
    Moderator Emeritus 15+ Year Member

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    Generally not hearing anything is a good thing. Hopefully if you were really struggling, they would communicate this with you in real time, giving you a chance to improve. Also, the first rotation of your internship is going to be hard and is going to have a steep learning curve for pretty much everyone -- your program should expect that. Interns are more likely to fail rotations for professionalism types of issues (showing up late, poor interpersonal skills, lying about things you've done, not following through on orders, etc) than for knowledge base issues. Also, while failing rotations and non-renewals happen, they're much more rare than SDN makes it seem.

    So most likely you're doing just fine. You could ask a chief about how you hear about evaluations if you're really worrying.
     
    Crayola227 and Winged Scapula like this.
  4. Crayola227

    Crayola227 The Oncoming Storm
    Physician 2+ Year Member

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    Check out my posts.
    They are all literally designed for you to avoid this.

    I talk about handling politics.
    Playing the game smart, positioning yourself to take care of your career, what to do if things go south

    Explicit advice on what your job really is (I had no idea) and how to be more "efficient" (cutting corners/being faster).

    Find out how evals are done at your institution, but I don't know that I would ask the chief. Ask some of your uppers. In an ideal world your PD and chiefs barely know your name because you're below the radar. Saying you're struggling or not sure if your performance is up to par or whatever weakness/insecurity can oddly put you under the microscope and lead to the unraveling you read about.

    Ask your uppers about the eval process goes.

    Ask uppers and attendings for feedback but gently. Especially if they seem to find you annoying, pick a good time to ask, they're the ones evalling you and you want to know what the annoyed ones want improved.

    Every intern has some dark fear in the corner of their mind of f*ing up and getting canned. Worst nightmare. This is normal, and exists even in your most confident and together-appearing peers.

    "Help I feel like a hypocrite but I feel like quitting" thread has good stuff about SMART feedback method, using this to structure asking for feedback.

    My posts, and the above advice on feedback, should keep you poised on the right track.

    If you have specific questions/worries advice needs, you can PM me.
     
  5. Crayola227

    Crayola227 The Oncoming Storm
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    I would add that "professionalism" issues are not universally why people get canned.

    Read my posts and you'll see.

    Examples are strongly advocating what's best for patient (there are times you will *know* current management isn't working/needs change) but don't make waves. Bite your tongue. Always just do what senior/upper want and any "challenge" to authority should not seem like so and be phrased almost as a question.

    Being slow. "Your job isn't spending time with patients, it's getting notes done." No joke.

    Don't know how much inpt you do but here goes:

    Your goal is answering all pages within 5 min or faster, some order requests you will satisfy like tylenol doesn't need nurse callback if your EHR is the kind where order to do's pop up on nurse's screen or FYI pages that don't seem important. At the start I still called all of the nurses back no matter what until they told me the kinda things they didn't want calls back on.

    Your goal is doing all admits, all H&Ps done and written timely, putting in all orders (there are.always orders you can feel confident on puutting in, the rest you can.wait until you can ask someone above you) speed pre-rounding, try to take no more than 5-10 min seeing patients in AM (sounds cruel but you need all the speed you can get) 5-15 min per prog note, good quick presentations on all patients, ask attending/senior how to make presentations better, all transfer and discharge summaries, updating families. Basically everything but calling consults because other docs don't want to talk to your dumbas$.
    I would time my activities if I had to.

    Now you're freaking because all of the above is overwhelming. It's OK. I just wanted you to know what the ultimate perfect goal is. Try hard to get there, if you're struggling with an element, ask upper how to do it better/faster and what tasks they want you to focus on first. They will be teaching and doing some of your job for you, you just want to be sure that you are meeting expectations and of course you still don't know what that is, and growing as they would like to see.

    Good problem lists, some sort of assessment. Don't worry too much on how good your plans are now, better to keep mouth shut than offer any guess that might seem dumb.

    Get survival guide (meant for residents not students), PocketMedicine or other specialty specific pocket-save-my-ass on plans reference. Resident organizations online often sell useful pocket guides.

    Worry about speed, learning system of getting **** done in hospital, knowledge comes with experience and speed will give you more time to think. What you don't know jot it down look it up later. During.day only read.bare minimun to get **** done. Later.in day read about patients and this other stuff. Hard to do but even 10 min on UTD is going to help.

    Learning nuts and bolts of doing like eveything, is what they want first out of you as ****'s gotta get done. Once you know the how, then you can focus on the medical knowledge part of it, the what and why.

    My practical advice in my other posts.
     
    #4 Crayola227, Aug 7, 2015
    Last edited: Aug 7, 2015
  6. Crayola227

    Crayola227 The Oncoming Storm
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    You would think you'd be in the loop if you were doing poorly, but not so. Ask uppers. Gently ask attendings. Do it early and often. Don't wait for evals, by then it's too late.

    Ask uppers how you can stay out of hot water. You don't want to express too much weakness but they are the best ones to ask.
     
  7. mvenus929

    Physician 10+ Year Member

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    It's not uncommon for interns to feel way out of their depth on their first inpatient rotation (even some on outpatient, but less so, because you aren't necessarily expected to do as much on an outpatient rotation). You should ask for feedback--I was horrible at this and got some surprises on my evaluations (that thankfully did not line up with what others said about me, so the PD shrugged them off). If you are given something to work on, make every attempt to work on it.
     
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