IM residency issue

[taeyeonlover]

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I'm technically supposed to be PGY2 IM resident but I have been on remediation since PGY1 year. There were concerns about my clinical performance and knowledge since then. One attending didn’t like me and others started to see flaws in me it all became worse from that. Towards the end of PGY1 year, my PD actually talked about having me leave the program. However, because my performance improved somewhat towards the end of PGY 1 year, CCC decided to keep me but stated that they will make another decision about me six months later, which would be this December.

Our hospital policy is that PGY I residents are supposed to take step 3 by the end of their PGY1 year. But because of the stressful situation, I couldn’t take it by the end of June.

I’ve been doing OK all my rotations. One attending told me that I improved and now work like a second year but others think I’m still kind behind compared to my peers. I feel like it’s hard to break the preformed impression that attendings have about you so if you make even one little mistake it all goes to my PD.

My PD asked me to take my step 3 exam by end of November so that he can include this as part of my evaluation by CCC in mid December so that he can decide whether to have me leave or not.

I think one attending recently said that my chart reviewing is slow compared to my peers (there was a misunderstanding on that part). My PD changed my schedule next month to a hard impatient medicine rotation for the entire month. He asked me to take step 3 by end of November so that the results will come out by mid December that way he can decide whether to keep me or not during the CCC meeting in December. Originally, it was ICU rotation for first two weeks and then easy elective rotation after that so I was thinking I would have some time during the last two weeks to study intensely but with this impatient medicine rotation, you work 12 days straight and take two days off so like around 70 hours a week

To make up for this, he is letting me do easy ambulatory rotation now where I only go to hospital once or twice a week.

I emailed and texted my PD to ask what exactly made him make this change in my schedule. He’s not responding to me at all. I also asked my chief resident and they are avoiding answering my question

I just took a practice exam and scored very poorly like mid 50s percent and I am wondering if I can get a passing score by end of November with the heavy month long rotation. I think he will have me leave the program if I fail.

I don’t even have time for therapy and I tried ssri once but my mind got all foggy and couldn’t think through a patient and one of my attendings reported me.

I have talked to a couple attendings and they seem willing to vote for passing me onto pgy2 but Im not completely sure and this whole situation is very stressful. I feel like I’m on thin ice.

Am I just not cut out for this career? Am I supposed to leave this program and find somewhere else? Every year I spend in medicine just feels like a battle to just survive since medical school.

Other than studying for the exam, Is there anything I should be doing in this situation to prepare for the worst?
Submit eras again now?

Also, if I am technically supposed to be pgy 1 until December and our policy is that you take step 3 until end of PGY1 year, am I still required to take it by November?

 

[GoSpursGo]

I'm technically supposed to be PGY2 IM resident but I have been on remediation since PGY1 year. There were concerns about my clinical performance and knowledge since then. One attending didn’t like me and others started to see flaws in me it all became worse from that. Towards the end of PGY1 year, my PD actually talked about having me leave the program. However, because my performance improved somewhat towards the end of PGY 1 year, CCC decided to keep me but stated that they will make another decision about me six months later, which would be this December.

Our hospital policy is that PGY I residents are supposed to take step 3 by the end of their PGY1 year. But because of the stressful situation, I couldn’t take it by the end of June.

I’ve been doing OK all my rotations. One attending told me that I improved and now work like a second year but others think I’m still kind behind compared to my peers. I feel like it’s hard to break the preformed impression that attendings have about you so if you make even one little mistake it all goes to my PD.

My PD asked me to take my step 3 exam by end of November so that he can include this as part of my evaluation by CCC in mid December so that he can decide whether to have me leave or not.

I think one attending recently said that my chart reviewing is slow compared to my peers (there was a misunderstanding on that part). My PD changed my schedule next month to a hard impatient medicine rotation for the entire month. He asked me to take step 3 by end of November so that the results will come out by mid December that way he can decide whether to keep me or not during the CCC meeting in December. Originally, it was ICU rotation for first two weeks and then easy elective rotation after that so I was thinking I would have some time during the last two weeks to study intensely but with this impatient medicine rotation, you work 12 days straight and take two days off so like around 70 hours a week

To make up for this, he is letting me do easy ambulatory rotation now where I only go to hospital once or twice a week.

I emailed and texted my PD to ask what exactly made him make this change in my schedule. He’s not responding to me at all. I also asked my chief resident and they are avoiding answering my question

I just took a practice exam and scored very poorly like mid 50s percent and I am wondering if I can get a passing score by end of November with the heavy month long rotation. I think he will have me leave the program if I fail.

I don’t even have time for therapy and I tried ssri once but my mind got all foggy and couldn’t think through a patient and one of my attendings reported me.

I have talked to a couple attendings and they seem willing to vote for passing me onto pgy2 but Im not completely sure and this whole situation is very stressful. I feel like I’m on thin ice.

Am I just not cut out for this career? Am I supposed to leave this program and find somewhere else? Every year I spend in medicine just feels like a battle to just survive since medical school.

Other than studying for the exam, Is there anything I should be doing in this situation to prepare for the worst?
Submit eras again now?

Also, if I am technically supposed to be pgy 1 until December and our policy is that you take step 3 until end of PGY1 year, am I still required to take it by November?

You are framing this incorrectly.

You were supposed to take the exam by the end of PGY-1. "Because of the stressful situation," YOU decided not to take the exam. From your program's perspective, they have already expended considerable time and effort to help you remediate and have granted you extra time at the PGY-1 level and an extra 6 months to study for your exam. If for some reason you have not prepared over the last 15 months to take the exam you were supposed to take months ago, that's a you problem, and if you fail it will be due to a failure to prepare over the course of your training rather than because your program changed this specific rotation around.

To your specific last question--arguing over whether you technically need to take Step 3 by November vs December is not going to be a fruitful argument. It is an internal policy that they maintain, and they decide what it means. If they want to say that because you got an extra 6 months at the PGY-1 level that you need to take step 3 in time to decide whether to keep you or not, I think it's hard to argue that it's an unfair policy.

I'm sorry because my intent is not to kick you while you're down, and clearly this is a very stressful situation for you. However my point is that you should not expect that your program will make any additional allowances for you within the normal workflow of residency scheduling. If you feel that you are heading towards a failing score on Step 3, then now is the time to request a formal leave of absence or FMLA, if such an option is available to you while on probation/remediation. You should do everything in your power to stay in your current program, and if possible, to pass the exam whenever it is determined that you must pass by.

 

[taeyeonlover]

You are framing this incorrectly.

You were supposed to take the exam by the end of PGY-1. "Because of the stressful situation," YOU decided not to take the exam. From your program's perspective, they have already expended considerable time and effort to help you remediate and have granted you extra time at the PGY-1 level and an extra 6 months to study for your exam. If for some reason you have not prepared over the last 15 months to take the exam you were supposed to take months ago, that's a you problem, and if you fail it will be due to a failure to prepare over the course of your training rather than because your program changed this specific rotation around.

To your specific last question--arguing over whether you technically need to take Step 3 by November vs December is not going to be a fruitful argument. It is an internal policy that they maintain, and they decide what it means. If they want to say that because you got an extra 6 months at the PGY-1 level that you need to take step 3 in time to decide whether to keep you or not, I think it's hard to argue that it's an unfair policy.

I'm sorry because my intent is not to kick you while you're down, and clearly this is a very stressful situation for you. However my point is that you should not expect that your program will make any additional allowances for you within the normal workflow of residency scheduling. If you feel that you are heading towards a failing score on Step 3, then now is the time to request a formal leave of absence or FMLA, if such an option is available to you while on probation/remediation. You should do everything in your power to stay in your current program, and if possible, to pass the exam whenever it is determined that you must pass by.

Ok thank you for your reply. But aren't I still considered PGY1 right now because of PGY1 extension?

I am not completely sure but I feel like if I request LOA they might ask me to resign because my PGY1 year was extended until december and my PD said if I don't demonstrate improvement by December, they will terminate my contract.

Is there anything else I should consider or do right now to prepare for the worst situation? should I submit eras again?

 

[GoSpursGo]

Ok thank you for your reply. But aren't I still considered PGY1 right now because of PGY1 extension?

I am not completely sure but I feel like if I request LOA they might ask me to resign because my PGY1 year was extended until december and my PD said if I don't demonstrate improvement by December, they will terminate my contract.

Is there anything else I should consider or do right now to prepare for the worst situation? should I submit eras again?

I don’t think arguing technicalities of whether you need to take the exam by November or December is likely to be fruitful for you. Regardless, it is a policy that is specific to their program so I can’t speculate on what it means.

I also am not sure if an LOA is possible for you. But if you have to take the exam in November, it sounds like you’re also at high risk of not passing which would result in you being dismissed anyways.

Submitting eras is not a good expenditure of your time. Focus on staying in the program you’re already in and passing this exam.

 

[smq123]

I just took a practice exam and scored very poorly like mid 50s percent and I am wondering if I can get a passing score by end of November with the heavy month long rotation. I think he will have me leave the program if I fail.

Step 3 has, historically, not been considered a difficult exam, particularly for residents in general medicine specialties. So it is extra concerning that you're a quarter of the way through 2nd year and are doing poorly. Where were your areas of weakness in the practice test that you took?

 

[CopaceticOne]

IM residents, especially after 18 months, should be able to pass Step 3 using their knowledge built from residency PLUS a review of peds & general OBGyn stuff.

You are missing the point that @GoSpursGo has been making - your institution expects people to have taken Step 3 by the time they have completed 12 months of training. Your PD is requesting you take it after 16+ months. This is a lifeline to potentially let you keep your training spot.

The fact that you still aren’t ready for passing the exam is 100% a you, & only you, problem. You’ve now had years to be ready for an exam you knew you would need to take. This may suck to hear, but you are finding yourself in a situation of your own making. There is no obligation for the program to give you any special accommodations at this point.