I need your advice.

[Rena]

---

Members do not see this ad.

I'm currently PGY3 at the University program. I'm an IMG and I practiced psychiatry in my home country.
It's been really rough time for me for the past several months. My outpatient supervisor told me that she is disappointed with me and she thought I was supposed to perform better given my previous experience and I'm even behind my peers. She told me that I can't make clinical decisions and I rely on her. In fact, there were some instances with control substances when I asked her advice (I don't have my DEA number yet). From that point my problems just started expanding. We have 2 clinics. I'm talking about the University clinic. They did the audit how many patients were seen at the University clinic and my numbers were low, especially in the beginning. They decided that I have the lowest return rate and came to conclusion (made an assumption) that I have a problem with rapport and interviewing skills. They told me that I have a good fund of knowledge but can't transfer my knowledge into clinical skills. They developed a plan for improvement (not remediation or probation yet). I must see specific number of patients, especially therapy Pts and I was also required to spend some time with PhD who should assess my interviewing skills.
It was a shock for me initially and got offended and defensive. I was doing everything possible to improve my situation. PhD didn't find any gross abnormalities, was kinda supportive. Finally I failed my OSCE. So, they were right.
I don't know what to expect next. I'm afraid of losing everything. I can be self-critical but it wouldn't help. What to do? It's a cry for help.

 

[LimbicResponse]

I can't offer any advice because I'm not at your level, but I think the fact that you have realized that the problem lies within you is a good first step. This is what comes to mind:

You mentioned you were from a foreign country. Do you mind sharing which one ? There are certain ethnic groups that have a lot of trouble adjusting to American culture. A couple of things that can help your rapport with patients is to become a bit more "Americanized"

1) how well do you speak English? If you have a heavy accent, you should consider taking some courses or hiring an expert to improve your pronunciation

2) How well do you dress? How often do you shower ? Having a very clean cut, well ironed, professional look that always smells clean makes wonders in patient rapport. It's very important to shower once if not twice per day.

3) Who are the people that you hang around with since you immigrated? If you have continued to maintain a circle of friends of similar background immigrants , this may limit your understanding of American culture. Really make an effort to implement some features of our culture without losing your identity.

4) How is your office decorated? Is it organized, clean, and well scented?

Do you have the option in your program to watch your mentors do therapy? How about a video tape? Reviewing some tape could help you understand more about the nuisances of patient comfort and rapport.

I like that you are trying to make a change and I think that given your interest in improving, you will have success.

Last: Drop your guard, this is not the time to act defensively, finding out whats wrong and making a change during the time that you are a resident will save you lots of headaches in the real world.

 

[Rena]

Thanks for your reply. I like your #2. Probably I need to take a shower X3 times a day and have a change of clothes in my office 🙂
I don't think I look much different from my peers. Maybe more official at times.

#1. I do have an accent, don't think it's heavy though. I'm much more fluent than in the beginning

 

[Rena]

I really do need an input from attendings.
Is that easy to fire someone? Can they say that I'm grossly incompetent and fire me?

 

[nitemagi]

I really do need an input from attendings.
Is that easy to fire someone? Can they say that I'm grossly incompetent and fire me?

More likely that you wouldn't be "fired," but would not have your contract renewed (most programs have yearly contracts only).

I would try and be as concrete and specific as to eliciting and documenting "deficits" and markers for improvement (how they can identify that you've improved). Scapegoating can definitely happen within academia, but your best hope is to be humble, focused, hard working, and model yourself on people who do well in your area of perceived deficits.

 

[Rena]

I already signed my contract for the next year.

 

[nitemagi]

I already signed my contract for the next year.

Did they sign it too?

If so, examine it again to see what it says about termination.

Failing an OSCE isn't the end of the world. I've unfortunately seen trainees fail multiple times then get retested enough until they passed (for political reasons). You just have to pass 3 to move on.

 

[toothless rufus]

Shower twice a day?! When? Why?! Unless you are slipping in a work out during the day, and who does that during a workday in residency? Or after.

 

[Dogdaysofsummer]

In my program it seemed like a resident would pretty much never be fired. We had one resident fall WAY below the bar and she wasn't fired. The PD just made people do remediation programs if there were problems.

It is hard to say why you are having a difficult time. It must be so difficult to get that sort of negative feedback. I think the best thing that you can do is to ask for frequent feedback and concrete suggestions for how to improve. Keep a positive attitude and try to show others you are doing your best. I know the PD at my program tried hard to help all the resident succeed but it is harder if the resident is being defensive, less than 100% honest, etc. I'm sure you are trying your best so just show your hard work to your supervisors.

Good luck.

 

[Rena]

In my program it seemed like a resident would pretty much never be fired. We had one resident fall WAY below the bar and she wasn't fired. The PD just made people do remediation programs if there were problems.

What did she do, just wondering? What does it mean fell below the bar?

 

[LimbicResponse]

Shower twice a day?! When? Why?! Unless you are slipping in a work out during the day, and who does that during a workday in residency? Or after.

I shower in the morning before work and when I get home after. It's really not that hard and quite enjoyable.

 

[michaelrack]

I usually only shower once a day. Fortunately, I was able to make it through residency.

 

[Scorcher31]

My outpatient supervisor told me that she is disappointed with me and she thought I was supposed to perform better given my previous experience and I'm even behind my peers. She told me that I can't make clinical decisions and I rely on her. In fact, there were some instances with control substances when I asked her advice (I don't have my DEA number yet). From that point my problems just started expanding. We have 2 clinics. I'm talking about the University clinic. They did the audit how many patients were seen at the University clinic and my numbers were low, especially in the beginning. They decided that I have the lowest return rate and came to conclusion (made an assumption) that I have a problem with rapport and interviewing skills. .

This just sounds off to me. An attending that says they are dissapointed in you like that, without real feedback or forewarning comes off as cold. You obviously practiced on your own in your country so how can she say you can't make clinical decisions and you rely on her too much. There are many attendings who want everything run by them that's a problem, but so is an attending that wants nothing to do with you and provides no input. I'm a number loving guy, but the clinic numbers could just be your patient load. You haven't been there that long or seen enough patients for it to be more than a curiosity.

Is it just the one supervisor or other attendings you work with that have a problem? It's very different if it is from a bunch of people vs 1 person. Still I agree with the other comments. Be humble/nice, find out concrete things you need to improve on and then demonstrate you've improved. Find out what you messed up on the OSCE and improve. Are they saying you can't connect with patients? When they say you can't transfer your clinical knowledge into clinical decisions could you give a censored example?

 

[Rena]

Little update:

Unexpectedly, I passed OSCE with 94%.

Also I got the next evaluation (not great but I can live for now): .... clearly has the knowledgebase to be a great psychiatrist. It seems she continues to require work on rapport development with patients. Her clinical skill would dramatically improve if she was able to divert more easily from her pre-planned discussion topic when needed by the patient's emotional or cognitive state. Her ability to develop treatment plans in general has improved, and she continues to grow & learn.


Don't know what to do with rapport because simply I don't think I have this issue.