How to deal with a bad residency evaluation

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IonClaws

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Hey people,

PGY-1 here, in Internal Medicine internship but in residency of another specialty. So I got my first written residency evaluation back back and basically, it wasn't very good. The main concern is that I required constant supervision by my senior, not sure whether that's expected or not for a block 4 intern.

I also have an issue with documentation. Generally, it's copying forward a previous day's progress note and forgetting to change one detail important to the next day's plan, which I am working on.

The eval also stated that I did not complete required tasks and resisted correction for physical exams; I am confused about these last 2 and do not understand where it was perceived that way.

Should I talk with the attending who wrote the eval and ask for clarification about these last 2 items?

Thank you!

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Unless it was your very first month on inpatient (I'm assuming it was inpatient based on the rest of your post), you should not require constant supervision in October of your intern year. Supervision, yes, but not constant.

It's reasonable to talk to the attending who wrote the eval, but you should ask for clarification in an 'I'm trying to learn' way, rather than a 'you got this all wrong' way.
 
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It would also be helpful to talk with your senior to get their impression of your performance. If this is just one attending who is very particular about how he/she wants things done that's one thing, but it's another if you're generally seen as a "problem resident" who is just trying to get through the year on the way to your actual specialty.

Either way, talking with this attending and showing that you want to improve is always a good thing, but I think getting feedback from your senior and others you've worked with will be helpful to determine how concerned you should be.
 
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It would also be helpful to talk with your senior to get their impression of your performance. If this is just one attending who is very particular about how he/she wants things done that's one thing, but it's another if you're generally seen as a "problem resident" who is just trying to get through the year on the way to your actual specialty.

Either way, talking with this attending and showing that you want to improve is always a good thing, but I think getting feedback from your senior and others you've worked with will be helpful to determine how concerned you should be.

I did talk with my senior and basically he said that although there were numerous problems at the beginning of when we worked together, I made great strides in improving. I think most of the problems reported were probably from my senior, which to my knowledge is not uncommon.
 
If it were expected for an intern, it wouldn't be commented on most likely, and if it were, it would probably indicate that it was to be expected or was just something to continue to improve on.

As far as talking to the attending, I would NOT go and say that you are confused about those points - if the issue is that they perceived that you resisted correction, sadly, asking for clarification on that might ALSO be perceived as resisting correction.

If you really wanted to know what you should have done for the PE, and you should, then you could go and ask what feedback they have for you on the physical exam and how you could do it better. That is different than saying you don't know what's wrong. I don't know if you catch the subtlety there.

As far as not completing tasks, again, I would not say "What tasks was I not completing?" I would ask, "What tasks can I improve my follow through on?"
 
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Copy pasta is common, as is problems with it, that in addition to the other less common complaints they stuck that in there, makes me more concerned that you are being viewed negatively.

Your above posts make me think that there is a subtle mental thing where you are trying to deflect all this.

What you say the senior says, tells me there is a problem, and that they are throwing in the "but you made strides in improving" to soften the blow, and you are reading too much into that softening.

This is because of the last thing you said which is minimizing.

Just because it's not uncommon doesn't mean that it's a very real problem that your senior had this to say about you to an attending, and that the attending essentially backed that up.
 
1) Take this stuff deadly serious. Do not write this off as uncommon or common or whatever helps you sleep at night and not a big deal.

2) Any perception of you being resistant to feedback is very, very bad. I don't care how you feel inside about the feedback, how much you love it, or hate it. You need to be extremely attentive to how you APPEAR to take feedback. I'm doing MMIs right now, and asked to rate even the BODY LANGUAGE of people taking negative feedback. So the need to monitor how you take feedback to that level is real.

3) You need to dot I's and cross T's. You might see others being sloppy about xyz. Not you, you are clearly under a radar. Your notes must be improved. You must be completing notes on time, being on time to conference, being early in the am, on time with your time sheets and evals and emails, etc etc etc. This goes into #4.

4) Task completion.

I'm not sure where the issue is for you, a lot of times a place to start addressing this, is how well you are doing with responding to pages (pages going past you to uppers no matter how infrequent, coupled with any other issues, is just adding grains of irritating sand), do you keep a good list of to dos, are you catching on to what are the to dos for patients as they come up?

Every single page, thing discussed with attending/senior/SW/patient, you need to assess if there is something to be added to your to-do for advancing care and towards dispo of d/c.

Frequently in a round table with senior and attending, what needs to be done is discussed but not delegated.

It's assumed you're tallying them all up, and that you are doing everything that isn't somehow obviously an attending or senior task.

Senior vs intern tasks are not always clear from senior to senior, so you need to learn how to have a convo at the start and as it comes up in real time, how your senior likes to run the service.

You need to make notes and then after say to your senior, "Can we run the list? I'm going to do xyz on these patients." This will help enormously. The list is your life.

Having a clear visual checklist you have created and ran through with the senior, and then checkboxing, and then at the end of the day quickly recapping where you ended up with each one (some of the items go undone for reasons outside your control) will improve not only your follow through on tasks but the perception of it. You want it known that tasks that are going undone are either because you were unaware (which itself needs addressed) or were outside your control ("I called SW at 10 am but was told they were not in and would get with me tomorrow,") and were not the result of you knowing what needs done and then just not addressing it for whatever reason. Once you are getting good at this with your list, then you can improve on making sure your list is comprehensive.

This may all be Intern 101 and not your issues at all, but it's basic stuff I've seen messed up that are not difficult to start to get right.
 
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1) Take this stuff deadly serious. Do not write this off as uncommon or common or whatever helps you sleep at night and not a big deal.

2) Any perception of you being resistant to feedback is very, very bad. I don't care how you feel inside about the feedback, how much you love it, or hate it. You need to be extremely attentive to how you APPEAR to take feedback. I'm doing MMIs right now, and asked to rate even the BODY LANGUAGE of people taking negative feedback. So the need to monitor how you take feedback to that level is real.

3) You need to dot I's and cross T's. You might see others being sloppy about xyz. Not you, you are clearly under a radar. Your notes must be improved. You must be completing notes on time, being on time to conference, being early in the am, on time with your time sheets and evals and emails, etc etc etc. This goes into #4.

4) Task completion.

I'm not sure where the issue is for you, a lot of times a place to start addressing this, is how well you are doing with responding to pages (pages going past you to uppers no matter how infrequent, coupled with any other issues, is just adding grains of irritating sand), do you keep a good list of to dos, are you catching on to what are the to dos for patients as they come up?

Every single page, thing discussed with attending/senior/SW/patient, you need to assess if there is something to be added to your to-do for advancing care and towards dispo of d/c.

Frequently in a round table with senior and attending, what needs to be done is discussed but not delegated.

It's assumed you're tallying them all up, and that you are doing everything that isn't somehow obviously an attending or senior task.

Senior vs intern tasks are not always clear from senior to senior, so you need to learn how to have a convo at the start and as it comes up in real time, how your senior likes to run the service.

You need to make notes and then after say to your senior, "Can we run the list? I'm going to do xyz on these patients." This will help enormously. The list is your life.

Having a clear visual checklist you have created and ran through with the senior, and then checkboxing, and then at the end of the day quickly recapping where you ended up with each one (some of the items go undone for reasons outside your control) will improve not only your follow through on tasks but the perception of it. You want it known that tasks that are going undone are either because you were unaware (which itself needs addressed) or were outside your control ("I called SW at 10 am but was told they were not in and would get with me tomorrow,") and were not the result of you knowing what needs done and then just not addressing it for whatever reason. Once you are getting good at this with your list, then you can improve on making sure your list is comprehensive.

This may all be Intern 101 and not your issues at all, but it's basic stuff I've seen messed up that are not difficult to start to get right.

Thank you for your help and with the subtly about asking for feedback for PE/completing tasks rather than asking for clarification.
 
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Hey people,

PGY-1 here, in Internal Medicine internship but in residency of another specialty. So I got my first written residency evaluation back back and basically, it wasn't very good. The main concern is that I required constant supervision by my senior, not sure whether that's expected or not for a block 4 intern.

I also have an issue with documentation. Generally, it's copying forward a previous day's progress note and forgetting to change one detail important to the next day's plan, which I am working on.

The eval also stated that I did not complete required tasks and resisted correction for physical exams; I am confused about these last 2 and do not understand where it was perceived that way.

Should I talk with the attending who wrote the eval and ask for clarification about these last 2 items?

Thank you!

If what you are asking is if trying to clarify what was stated in your evaluations is the convenient thing to do, I'd say it's not...more probably than not it will lead you to nothing of use because it's unlikely you'll get the attending to come with a sincere explanation on what he based his comments on or his motivations to write that in your evaluations if he or someone else already hasn't had a word with you about some specific instances in which you left tasks unfinished, or didn't do an adequate physical examination; but come on, we all know you have a strong idea of where the comments on this last thing, and probably the rest of what you claimed you didn't understand, are coming from.

If it was somehow true you have little idea what those comments were all about then what you're dealing with is a very malignant attending or senior, and this makes all the more futile an attempt to get your attending to clarify what he wrote on your evaluation, for you won't learn much other than that he isn't doing anything on goodwill.

My advice would be try not to worry about whatever was wrote on your evaluations more than what your seniors or attendings are telling you or saying about you day to day, but everything put into the perspective of what you know your deficiencies are. Whatever they say about you or write on your evaluations may or may not be fair or even an accurate reflection of your deficiencies, but more than try to figure out exactly what they mean with the stuff they put in your evaluations or how they score you, your focus should be identifying by yourself what your deficiencies are and try to work better and overcome as much of them as you can. Only if you get upfront and clear criticism of the way you do certain things or of the percieved deficiencies others see in you is what you could reliably use as information from which you can modify the way you work to better suit how they want you to do your work, and maybe overcome a real or important deficiency.
 
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Also, I mean this kindly but be careful to not even give out the slightest whiff of not wanting to be there/not liking IM. Everyone knows you are in a different advanced field so it will be extra on people’s radars.

I struggled with this as a transitional. I hated outpatient peds with a fiery passion and my first month (of 3) evaluations weren’t too great. I decided I would will myself to have a good attitude and to try to learn something everyday. My evals improved tremendously. And now being able to guess the age of someone’s baby accurately is a good party trick.

Make an effort not to kvetch with your fellow residents, especially your seniors (who are in IM). Try to learn the material, correct what they told you to correct, and be as damn pleasant as possible for the rest of the year. Giving out of a whiff of marking time until PGY2 will sink you so hard and maybe torpedo your career in what you really want to do.

Plus IM is the bread and butter of medical care - you can surely gain a lot from the training if you try to. And I’m not in IM saying that.
 
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Eh, I don't know that this is a sign of malignancy. People can be crappy at giving face to face in real time feedback, or just feedback period. Often they can't tell you exactly what's wrong OR how to address it, but they sure can write it in an eval.

I wouldn't just try to identify weaknesses on your own - it's the ones you're blind to that are the biggest problem, not the ones you're aware of.

You need to do your best to elicit feedback, you might even have to do some research to determine the best questions to ask to get specific useful results out of people.

If you're lucky, what you can get people to tell you, is how *they* deal with what you're struggling with. Sometimes they can't tell you what's wrong and how to fix it, but they can tell you how to do things to their liking or share their own system. Maybe.

The last piece of this, is that if you want this precious in real time feedback, you need to do 2 things well: kindly push hard for it, and then lap it up like a happy lap dog with chicken liver. Even total jerk attendings and anyone else, often don't like "interpersonal conflict" or "hurting people's feelings."

So you need to come off like no matter what someone says to improve you're going to go skipping down the hallway excited to implement, not like you're going to go cry in a closet or try to defend yourself. This makes it "emotionally safe" for people to express negative feedback to you, and then the intel will flow more freely. People can start small with the criticism, and your excited happy response can then encourage more deeper darker secrets. Which is what you want, not the pat on the back with a "better next time" response.

How to be welcoming of feedback? You will have to school your face, your voice, your body language.

So when you get this feedback, DO NOT point to anything positive that contradicts it in any way. It's OK to say, "If I have this right, I need to improve x,y,z. Is this ____ thing that I am currently doing effective? What else can I do?" One is that double-checking the things you think you're doing right, is useful in itself, and sure, this could end things on that positive note about you, but more importantly it could give you more useful info. Calibrating yourself is not just figuring out what you're doing wrong, it's also figuring out what things you're doing "right," you're actually doing right. But no "buts," and you can't focus on doublechecking what you're doing right without totally acknowledging what's wrong.

Otherwise, do not point to anything you are doing/have done that contradicts the feedback. Just take it. If they point to something specific "You didn't call the SW" you could say, "I did call them, they weren't in, I should have been clear on that." Even if you have to factually disagree with feedback, you still need to validate it in some way. Validating someone else's feedback, no matter what you think of it (unless it's total character assassination of your motives that isn't true like lying, etc), is part of being "receptive."

If what was being said was, "You're not completing tasks, you didn't call SW," while it's fair to point out, "I did," because sometimes things get colored or misinterpreted, the point is that they're holding this against you for a reason. So you say, "I did call SW, but I think I understand this as an example of the kind of issue for me to improve. Do you think there is a pattern to the sort of thing I'm not catching? Or a strategy I could use?" Often there's silence, but at least you're asking for feedback. When you get this silence (hopefully you get better feedback) then you can say, "Perhaps working more closely on my list and being sure to run it earlier with the senior would help." It doesn't matter if the solution you propose is one you think you are already doing and that you can't do better with that than you are.

TLDR:
You must elicit feedback. There are strategies to doing this well. It is important to focus more on validating the concern and proposing a solution for you to carry out, then trying to correct someone on their perception.
 
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Eh, I don't know that this is a sign of malignancy. People can be crappy at giving face to face in real time feedback, or just feedback period. Often they can't tell you exactly what's wrong OR how to address it, but they sure can write it in an eval.

I wouldn't just try to identify weaknesses on your own - it's the ones you're blind to that are the biggest problem, not the ones you're aware of.

You need to do your best to elicit feedback, you might even have to do some research to determine the best questions to ask to get specific useful results out of people.

If you're lucky, what you can get people to tell you, is how *they* deal with what you're struggling with. Sometimes they can't tell you what's wrong and how to fix it, but they can tell you how to do things to their liking or share their own system. Maybe.

The last piece of this, is that if you want this precious in real time feedback, you need to do 2 things well: kindly push hard for it, and then lap it up like a happy lap dog with chicken liver. Even total jerk attendings and anyone else, often don't like "interpersonal conflict" or "hurting people's feelings."

So you need to come off like no matter what someone says to improve you're going to go skipping down the hallway excited to implement, not like you're going to go cry in a closet or try to defend yourself. This makes it "emotionally safe" for people to express negative feedback to you, and then the intel will flow more freely. People can start small with the criticism, and your excited happy response can then encourage more deeper darker secrets. Which is what you want, not the pat on the back with a "better next time" response.

How to be welcoming of feedback? You will have to school your face, your voice, your body language.

So when you get this feedback, DO NOT point to anything positive that contradicts it in any way. It's OK to say, "If I have this right, I need to improve x,y,z. Is this ____ thing that I am currently doing effective? What else can I do?" One is that double-checking the things you think you're doing right, is useful in itself, and sure, this could end things on that positive note about you, but more importantly it could give you more useful info. Calibrating yourself is not just figuring out what you're doing wrong, it's also figuring out what things you're doing "right," you're actually doing right. But no "buts," and you can't focus on doublechecking what you're doing right without totally acknowledging what's wrong.

Otherwise, do not point to anything you are doing/have done that contradicts the feedback. Just take it. If they point to something specific "You didn't call the SW" you could say, "I did call them, they weren't in, I should have been clear on that." Even if you have to factually disagree with feedback, you still need to validate it in some way. Validating someone else's feedback, no matter what you think of it (unless it's total character assassination of your motives that isn't true like lying, etc), is part of being "receptive."

If what was being said was, "You're not completing tasks, you didn't call SW," while it's fair to point out, "I did," because sometimes things get colored or misinterpreted, the point is that they're holding this against you for a reason. So you say, "I did call SW, but I think I understand this as an example of the kind of issue for me to improve. Do you think there is a pattern to the sort of thing I'm not catching? Or a strategy I could use?" Often there's silence, but at least you're asking for feedback. When you get this silence (hopefully you get better feedback) then you can say, "Perhaps working more closely on my list and being sure to run it earlier with the senior would help." It doesn't matter if the solution you propose is one you think you are already doing and that you can't do better with that than you are.

TLDR:
You must elicit feedback. There are strategies to doing this well. It is important to focus more on validating the concern and proposing a solution for you to carry out, then trying to correct someone on their perception.

Totally unrelated, but I always marvel at the length of your posts.
 
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