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IMG PGY-1 Terminated from residency - SERIOUS HELP NEEDED

Discussion in 'General Residency Issues' started by Dr. Hopes, Feb 6, 2018.

  1. Crayola227

    Crayola227 Ice Cold Barbie
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    The bolded.

    Although, unfortunately, whether or not you get the first spin from the resident or not.... can depend on a number of factors.

    I've had seniors you practically had to BEG and cajole into helping or seeing your quite ill patient. You hope this doesn't happen.
    It's true that the best intern armor is deflecting too much responsibility by kicking things up the chain. It's saved my ass. I've had times I had to go above the senior to the attending. It's something you really, really, don't want to do, but you can't let your patient sink with you in the boat too.

    "But the senior/attending told me to" is a really good response early on, unless it's something so stupid even an intern should know it is not a good idea to follow through on.

    Paging or texting is not adequate alone. Pages vs texts - one is hospital approved and expected that officers will have on. Personal cell phones, not so much.

    I would page, because that actually creates a record of something your senior is responsible for seeing, however, if that gets no timely response, you should page again, and in anything serious you page AND call. Because again, one creates a record, and one is a more direct method of trying to track them down. Be sure your page makes the situation clear as being serious and send more than one to explain if you must. Send an overhead page if you can.

    If you can leave the patient, go physically track down your senior or attending if you must, if you can reasonably find them. Send a nurse if you can't leave bedside.

    If you have to, and I've done this, approach any attending that might reasonably offer assistance. I've grabbed a hospitalist that wasn't on the teaching service when it seemed like help just wasn't coming or wasn't coming fast enough.

    In the scenario with dosing, I've also ran something like that by anyone senior to me that could help - another senior in the room, an attending sitting next to me even if they weren't on my service. People expect interns to reach for a lifeline wherever they can get it. If it's not appropriate typically they'll help you find someone who should be helping you (assuming you tried already). It might be an annoyance but we all know that interns have to kick things up.
     
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    #51 Crayola227, Feb 14, 2018
    Last edited: Feb 14, 2018
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  2. Crayola227

    Crayola227 Ice Cold Barbie
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    Reading about this scenario, I really wonder if this was more of a straw broke the camel's back type thing, or that given reasons they wanted you gone this was a moment to highlight to justify it.

    When I discuss a drug like this in a scenario like this with an attending, and I don't know dosage for a patient that doesn't seem terribly sturdy, once the attending says, "sure, give olanzapine," I'm asking, "OK, is there a dose you prefer?" Some won't know off the top of their heads, and some might roll their eyes because you can look it up and should know how to do so. Better to ask.

    Also, in elderly, you ALWAYS have to be cautious about centrally acting meds. For such meds, I don't know that I would ever give the full UTD dose. Better less and then add more when you're just trying to hit the sweet spot of enough sedation to cool down hyperactive delirium but not obtund the patient. Keeping in mind such meds are actually deliorgenic (I've written elsewhere on this).

    This is all hindsight, but hopefully any one coming up in training can read this thread and rather than just fear, learn something. It's never too early to learn this stuff.
     
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  3. SilverCat

    SilverCat The Friendly Reapp Cat
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    Probably a stupid question, but how much of these emergency scenarios should a new intern handle on their own? I feel very incompetent--and in all of these scenarios OP mentioned wouldn't know what to do. I'm doing both an EM rotation now and am doing somewhat poorly--i.e.--completely missing obvious things that I shouldn't. I'll be doing a MICU rotation before intern year as well, but is there anything else to do if we're worried we'll be the incompetent resident? Just have a feeling of dread reading this story and don't know what to do.
     
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  4. siliso

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    In my experience it’s more often that a person has hit their ceiling of ability to adapt to expectations. Often people who have been on the grind with extraordinary effort even to get to residency and have maxed out their capacity when the line speeds up once again. And it’s heartbreaking and we do everything to help them succeed or help them get into a situation where they’ll be able to succeed. People with character problems who do a huge professionalism violation (like didn’t actually graduate med school but managed to get a training license on a preliminary transcript and thought it could slide under the radar) not so heartbreaking.
     
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  5. siliso

    Physician 10+ Year Member

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    If you’re an intern then assess the situation and make a plan and then get it co-signed by your supervisor before taking irreversible action.
     
  6. Psai

    Psai This space for lease
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    You're not expected to know everything or even anything. Always keep your senior in the loop, especially if you have a single doubt.
     
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  7. siliso

    Physician 10+ Year Member

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    You are incompetent to practice independently as an intern, and that is expected and okay. What’s important is to recognize your limitations and seek supervision. Take ownership and make a plan but get it verified - then execute.
     
  8. CDI

    CDI Senior Member
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    What the...this post scared the crap out of me and I'm just about finished with residency. Bout to open up a damn book and teach myself!

    The fact that OP is actually a coherent IMG and at least gives off the impression as being genuinely understanding of their own mistakes (without blaming others) worries me even more.

    Clearly a malignant program with some kind of odd agenda. I feel for OP. Trying hard but the man trying to hold em back.

    This also gave me flashbacks about having a tough time as an intern. Both getting into residency and then as an intern with no clinical US experience aside from research. The one clinical "error" I've made in 3 years was on my first month on floors, I had a rapid called on patient cause of narcs beings given to close to each other. Patient was awake and reading a book, but was running soft on scheduled vitals check and the nurse bugged out. Since then I became a narc Nazi.

    Advice to future interns: Bug your upper levels early on in residency (rather than later). You're an intern, and expected to not know squat. I bugged mine for every bit of knowledge I could get until I was comfortable doing stuff on my own. They might get annoyed but if they're a good upper level, they'll realize why you're asking.

    Board scores don't mean much aside from filtering to get into residency. Once in, all bets are off.

    I got 50-60 points less than our top scoring IMG on literally all the USMLE exams. Yet, just 3 days into our first floor block as interns, he turned in his badge to the PD cause he was so stressed out.

    Except maybe for rocket science...EQ >>> IQ

    And for OP, do whatever you gotta do to stay in your program. Once you're out there with a dismissal as an IMG, no one will ever look in your direction again. Sad part is, as an upper level, I bet you would have done a damn good job.
     
    #58 CDI, Apr 8, 2018
    Last edited: Apr 8, 2018
  9. NeurologyHopeful2018

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    An IMG quit after just 3 days on the floor?

    At my home program which is semi-malignant - the interns carry no more than 2 patients for first week!
     
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  10. Raryn

    Raryn Infernal Internist / Enigmatic Endocrinologist
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    At the program where I trained, you walked in to the same load you'd be expected to carry depending on where your team was in the call schedule.

    I had 8 patients my first day. Some people had the full 10 associated with a post-call day.

    Lets just say that when it came to logging duty hours the first month... we were... flexible...
     
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  11. CDI

    CDI Senior Member
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    Yep. Third day on the floors he turned in his badge.
    PD gave him 3 days off to get his ish together.
    Came back and did okay after that but continued to have occasional trouble when the admits got hectic.
    Consistently went way over duty hour limits to get work done.

    Two patients for the first week probably makes the most sense. We had no such thing unfortunately - Day 1, "Here are your 10 patients, good luck and God bless!".
     
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  12. PlutoBoy

    PlutoBoy Sic transit gloria mundi
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    This actually happens?!
     
  13. NeurologyHopeful2018

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    Is your program malignant? Your program is suppose to be care about "resident wellness" and provide as much support as humanly possible to help the residents succeed. It is a major RED FLAG on the program when a resident is not able to successfully complete the program - let alone walk out after a few days.
     
  14. Perrotfish

    Perrotfish Has an MD in Horribleness
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    If someone walks out after 3 months the program may be malignant. If they walk out after 3 days it's on them
     
    #64 Perrotfish, Apr 8, 2018
    Last edited: May 2, 2018
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  15. Doctor Christmas

    Doctor Christmas Membership Revoked
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    Me too! I started post call day, and had 9 brand new patients. It was not a fun day.
     
  16. FutureInternist

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  17. CDI

    CDI Senior Member
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    No. That's called residency. Welcome to the real world...
     
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  18. Siggy

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    None.
    There are two answers that are always right and should be your default until you get your footing.

    1. "Give me a minute and I'll come see the patient" (and go see the patient)

    2. "Give me a second and let me check with my senior resident."
     
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  19. evilbooyaa

    Staff Member Moderator Verified Expert 7+ Year Member

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    Semi-malignant, no more than 2 patients in the first week? Sounds like they're being coddled.
     
  20. ThoracicGuy

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    My first rotation on my intern year we had around 40 patients on the census at the pediatric hospital... There were no caps.
     
  21. FutureInternist

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    It probably has to do with the logistics of a new computer system, figuring out which specialty team is on call, not knowing your way around the hospital etc.

    Not seeing 8-10 pts for the first few days will in NO way hinder anyone’s training but will give them time to get their bearings and start on likely the most intense part of their life, in a good way.

    At my program, the senior routinely saw 10-12 of our 14 pts on first day, and then give some of their pts to the intern on the 2nd day while they saw the new ones from overnight.

    By day 4-5, interns know where everything is, which printers work etc and then the workload go up to 10-12 for them.
     
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  22. Justanotherresident18

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    OK, I just had to respond to this thread, not to communicate with OP, but to re-assure the other soon to be PGY1s who are understandably nervous reading this.

    Lets just say, I might know who he or she who wrote this post is. To re-assure everyone.. this might be a large university program, interns leaving are generally unheard of, as there is a massive amount of support from both senior residents and the administration.

    I'm not going to respond to OP directly, because he or she might be in an appeals process, and I don't want to completely call them out. Suffice to say, there is (understandably) a LOT they left out of the initial post.

    OK, interns, here's how not to be fired from a first year internship, These may be things that the OP struggled with:

    -Have a sense of urgency when returning pages or calls from nurses, midlevels, or other physicians. Take ownership of your patients, and never let it LOOK like you just don't care. Even if you have some degree of confidence that "sure a little fluid bolus for this hypotensive patient will be enough, I wont bother my resident with a call, I'll just text..." - NOPE -you're a PGY1, your goal isn't to show everyone you were a great physician you were in your home country, your goal is to show you can gather information, know when it is urgent, show you can work as part of a larger team, and communicate said information in an appropriate manner. If you have ANY concern, reach out to your senior resident, or your attending. Let the nurse on the other end KNOW you are doing this. Make an effort to show ownership of the situation, and see it through.

    -Be respectful to nurses both on the phone and in person. I don't care how in your home country doctors are the be-all end-all. You have to know that in the USA, in US hospitals, nurses are valuable members of the team, and need to be kept in the loop. For the love of god, when you call them back be mindful of how you sound. Yes it may be a potassium of 3.4 at 2am... but if the nurse can audibly hear you rolling your eyes on the other end of the phone, your chiefs or attendings WILL be getting a call from the nurse manager. If this happens repeatedly, you are in rough shape.

    -Be open to feedback. When an attending or resident is telling you how to improve (In any way), you may think you are being sincere by going "yea yea yea, ok ok ok", but it doesnt come off that way. Use closed loop communication - tell your attending, "That makes sense. I see why doing XXX was wrong, I'll try to do YYY in the future, thank you".

    -Be mindful of being in the moment. What you do when you think no one is watching (ie, checking social media on your phone, in clear view of an entire room during morning report) is unprofessional and disrespectful to everyone's time. The way you dress, the way you interact with family members, the way you carry yourself on rounds... there is SO MUCH non-verbal, non-medical-knowhow behavior that affects how people see you.

    -Finally, be aware of when you're being evaluated. If the uppers let you know there is a concern and you are being carefully watched by the program, you need to do your best to show that WHATEVER it is they are critiquing you on, is improving. Once again, critiques might be character or personality based-- these are just as valid as critiques based on lack of medical knowledge. Hell, I'd rather have an intern who has deficient medical knowledge over deficiencies in work ethic or character flaws/behaviors.

    You really only get one or two first impressions, early on in intern year. Like it or not, that will set the course for how you're perceived, and negatives are hard and slow to fix. You WILL NOT get along with everyone in your program or hospital sites. Doesn't matter. You may have a resident who says something mean... don't get into a fight with them, smile and say thank you and move on.

    If you guys start intern year as eager to work, eager to take feedback, eager to be part of an entire hospital-wide team, and eager to take ownership of your patients, you will be fine. Do not be afraid of this post.
     
  23. BigRedBeta

    BigRedBeta Why am I in a handbasket?
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    Absolutely agree with the bolded part - whenever I was supervising trainees, be they medical students when I was an intern, interns when I was a senior, or upper level residents as a fellow, I could absolutely make a difference with deficient medical knowledge. It's a lot harder to change character or behaviors (like inefficiency) and often times impossible to fix a terrible work ethic (usually because the person things they are working as hard as they can, or doesn't care enough to give any more effort).
     
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  24. Kissmyabjj

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    Damn...


     
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  25. Mig2018

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    Could you please update us!
    Your story is too familiar. The exact thing that happened for me! I resigned and they told me it will be a clear resign! But actually it was not! I talked with lawyer, but it was too late to talk with a lawyer! I had already resigned!
    They just report my mistakes! No body told me what was wrong and no body try to correct me when they saw that I was doing wrong!
     
    #75 Mig2018, Nov 7, 2018
    Last edited: Nov 7, 2018
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  26. Crayola227

    Crayola227 Ice Cold Barbie
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    Yep, never sign things re: your career with a medical board, hospital, physician's group/clinic, or a training program without consulting an attorney whose purview might include the document at hand.

    In my own life, I have never regretted the times I consulted a reputable attorney, and God knows they are not cheap. OTOH, I regret more the times I should have gotten one, and didn't.
     
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  27. Make Or Break

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    Thanks a ton for this. I havent even started intern year yet and was already freaking out after reading OP's post. You da best.
     
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  28. doctorKAT

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    Just wondering what can the OP's former PD do to help the the OP in looking for another position?
     
  29. aProgDirector

    aProgDirector Pastafarians Unite!
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    They can give them a fair summary of their strengths and weaknesses, and can forward any notices of open PGY-1 positions.
     
  30. firstaidhelp

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  31. ThoracicGuy

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    Is this an ad?
     
  32. gutonc

    gutonc No Meat, No Treat
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    More of a rant.
     
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  33. ThoracicGuy

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    I thought it was more the guy was advertising his own site/blog/rant/whatever.
     
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  34. gutonc

    gutonc No Meat, No Treat
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    I think we banned the account that was spamming that site awhile ago.

    The site is a whole bunch of crazy, but it's non-commercial.
     
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  35. Crayola227

    Crayola227 Ice Cold Barbie
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    I like the site, it makes some decent points and has some links to more reputable papers/sources. Some of the advice for struggling residents is valid in my opinion.
     
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