Let me tell you what happened from the beginning. I graduated from a caribbean top 4 med school in 2008. I have good step scores, STEP 1 - 94% and STEP 2 CK- 92% and passed my STEP 3. Matched in prelim surgery but resigned from that program in the first week as the pace was very fast and I could not keep up. I did some externships afterwards to beef up my application and was able to successfully match into a community FM program 2 years later. The year was going fine until I had one attending in obgyn mid-way in my intern year who started grilling me while on service. He was "pimping" everyday on the ward and I tried to answer him even though I may or may not have been correct. For some reason, he singled me out and did not "pimp" other residents nearly as much. I heard other residents, mainly AMGs, laughing at my answers when I was incorrect. I am not sure why he was always going after me. I did not step on his toes or say one wrong thing. I am a mellow, soft spoken male and I never had any "attitude" problems. Somedays, I just felt terrible inside but I gathered the strength to carry on through prayer and attending church. I was able to carryout the deliveries without any problems and the nurses and staff had a good opinion of me. The evaluation was a huge shock to me as it said "Fail" at the bottom. I was marked low on EVERY single competency on the evaluation. I couldn't understand it. I am not that terrible and it didn't make sense. In all my previous 6 rotations, I received average to above average evaluations. My program director called me to her office and told me that you are placed on probation as of now. I agreed and was made to repeat the rotation after completing the rest of the intern year. I started a subsequent ob/gyn rotation at the end of my pgy1 year, and to my bewilderment, the previous ob attending was to be my attending again. I know as an IMG I had to do "man up" and continue. He continued his wrath on me and I continued with the daily bashing. At the end of the rotation, history repeated itself and I got another "Fail" on my evaluation. I was called again to my program director's office. The evaluation was nearly identical, and stated I had improved minimally but had worsened in other areas. She sat at her desk with 2 other attendings standing beside her staring directly at me. She asked me to either resign now or be terminated. I immediately felt my stomach churn and press up against my diaphragm into my chest. My heart began to race and I felt a pulsing sensation in my head. I knew this was it. I am done. I am no longer going to be a doctor. I sat silent. She repeated to me once again the ultimatum making sure I had heard. I said in a barely-audible tone "I will resign". I did not get an internship completion certificate because of that Ob/gyn rotation. I knew I was screwed big time. I left that program and have not been able to get a PGY2 or PGY1 spot in the match. It has been 3 years now. What can I do now? Am I done with medicine? Please offer some decent advice. I still have loans to pay back. God bless...
IMG terminated from FM residency. What to do now?
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You quit one program and resigned from another, I'm sorry my friend, it looks grim.
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Yeah, I think it's hard to take seriously your story that you were an "average to above average" resident and faultless when the story starts out with you quitting a different residency within a week because you "couldn't keep up."
Pimping is a part of residency, and usually med school as well. It's ideally your opportunity to shine, not something you should view as harassment. Feeling like you are being hassled by pimping is normal early on in med school but by residency it's supposed to be old hat. I think part of the issue is that your "lite" offshore med school rotations and externships perhaps didn't prepare you for this skill as well as the rotations your US counterparts had. Doing "deliveries" is only part of residency training -- attendings need to know you have a working knowledge base, and so they ask.
unfortunately, you may have used up your chances in medicine. What other interests do you have?
Pimping is a part of residency, and usually med school as well. It's ideally your opportunity to shine, not something you should view as harassment. Feeling like you are being hassled by pimping is normal early on in med school but by residency it's supposed to be old hat. I think part of the issue is that your "lite" offshore med school rotations and externships perhaps didn't prepare you for this skill as well as the rotations your US counterparts had. Doing "deliveries" is only part of residency training -- attendings need to know you have a working knowledge base, and so they ask.
unfortunately, you may have used up your chances in medicine. What other interests do you have?
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While pimping is certainly part of med school and residency, it is also 100% true that some residents are picked on and pimped mercilessly while others are not. Let's not pretend that that never happens.
So it may be that OP rubbed an attending the wrong way and he/she made it their mission to make their life miserable. Sometimes that happens also.
With that said, I think that OP may not have been as academically strong as he should have been.
I felt overwhelmed when I started residency and was like man I should quit! on my first day but pulled through. My intern recently told me that they were overwhelmed initially but that they were learning tons and what not. There isn't one person I know that has not felt overwhelmed initially and that is normal part of training. However OP quit the first week! That is not a good sign. That already gives a red mark on someone's profile to quit at the week mark.
So I think this was the perfect terrible combination of not the best academically prepared resident + attending who was pissed = failure.
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Since this is all water under the bridge for the OP at this point, the following advice is aimed at people who may feel like they are currently in the position that he found himself in 4 years ago: Getting relentlessly pimped by one attending is a strong hint that they suspect that your knowledge base is not up to par. It is also a strong hint that you should correct this as quickly as possible. Obviously, as a resident, you are not going to have the time to master everything in detail, but you should be able to demonstrate fundamental knowledge. One can never predict exactly what one is going to be asked, but there are a few broad areas that are fairly predictable.
Generally, one thing that anyone will get pimped on, and rightly so, is the risks and benefits of their clinical intervention. Know these.
If you are performing any sort of procedure, be SURE to know the anatomy involved.
If you prescribe or order medications, make sure you know the side effects of them, and how they work.
Often, when seniors or attendings pimp interns relentlessly, it is often because they witness the intern performing "monkey see, monkey do" behavior, such as ordering medication reflexively without appearing to have evaluated the particular clinical context of each patient. Know your patients, understand your interventions.
So, how to correct this... If you find yourself in a hole where it is clear that someone is questioning whether or not you actually attended medical school, be sure to refresh the fundamentals. In the case of OB/GYN, if you are getting tripped up by basic things, read blueprints, or something like that. You may have read it before, but a quick re-read may bring you more insight. Identify the basic tasks you have to do, and make sure you understand the science behind them, and can explain it in brief layman's terms. Be clear, and concise when answering questions. Don't run your mouth and give people opportunities to find gaps in your knowledge.
To the OP: Sorry buddy, that's a rough place to be. Medicine is far from the be all end all of everything. If I were you, I'd start looking for something else.
Generally, one thing that anyone will get pimped on, and rightly so, is the risks and benefits of their clinical intervention. Know these.
If you are performing any sort of procedure, be SURE to know the anatomy involved.
If you prescribe or order medications, make sure you know the side effects of them, and how they work.
Often, when seniors or attendings pimp interns relentlessly, it is often because they witness the intern performing "monkey see, monkey do" behavior, such as ordering medication reflexively without appearing to have evaluated the particular clinical context of each patient. Know your patients, understand your interventions.
So, how to correct this... If you find yourself in a hole where it is clear that someone is questioning whether or not you actually attended medical school, be sure to refresh the fundamentals. In the case of OB/GYN, if you are getting tripped up by basic things, read blueprints, or something like that. You may have read it before, but a quick re-read may bring you more insight. Identify the basic tasks you have to do, and make sure you understand the science behind them, and can explain it in brief layman's terms. Be clear, and concise when answering questions. Don't run your mouth and give people opportunities to find gaps in your knowledge.
To the OP: Sorry buddy, that's a rough place to be. Medicine is far from the be all end all of everything. If I were you, I'd start looking for something else.
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I mostly agree with your post in that (a) attendings who sense that a resident is not up to par are more likely to keep their feet in the fire. Much as animals smell fear, some attendings smell unpreparedness and may latch on like a pit bull. But most of the time for them it's about training, not abuse -- the struggling residents are supposed to use that as impetus to get better, work harder, and most of the time that's also the attendings goal, not to railroad someone out of residency. It's actually quite a pain to train and replace a resident so most places aren't quick to do so, if there's someone slightly off the target but seems salvageable and willing to put in the effort to fix things. The people who get blindsided are the ones who lack the insight that they are, in fact, not keeping up with their peers, even after a meeting with the PD.
I see a lot of "poor me, it's wasn't fair that I was singled out, I am average to above average in everything else" sentiment in OPs post, but not a lot of "because the attending was pimping me so hard, I stepped up my studying efforts 200%". OP noted he prepared himself for further pimping through "prayer", but honestly in most religions God only helps those who help themselves and so OP probably should have tried harder to find salvation in one of the many review books, not church. Yes, I am probably being totally unfair here, but the odds of a program systematically trying to get an "above average" resident to retire are pretty low. More likely OP was falling behind and they tried to light a fire under him.
(b) I agree it's normal for an intern to feel overwhelmed, and quite abnormal for an intern to quit in a week. That's probably the object lesson here -- intern year is a steep learning curve, it's supposed to be hard and part of the learning value is the intensity. You have to be the kind of person that gets up and dusts yourself off each time you get floored, and redouble your efforts, not decide the pace is too fast and quit. That OP quit his first residency in a week sort of dovetails with the other part of the story, that when goings later got tough, instead of redoubling his efforts and becoming a Jedi master at pimping, he basically capitulated.
Anyway, that's my read on OPs post. Probably unfair and harsh and tainted by the very minuscule handful of residents I have seen meet similar fates over the years because they "just didn't get it". But OP seems to have had his second chance and now probably has to figure out what other career paths he might be interested in. We can't answer that one.
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I agree to some extent with your thought process in the sense that the way you are describing things is probably how the average, non malignant attending thinks but there are exceptions. For example, I was graded by ALL my attendings as excellent to superior in my previous residency, yet I had one attending who just had it in for me and graded me "marginal." I was stunned. I said ok, let me work more and try to impress this person, and still to no avail it was the same harshness constantly, to the point where OTHER attendings and PD stepped in and got involved because it became super abusive. Later he also asked me out for drinks and dinner, so that's where that was going. My point is that sometimes attendings can simply be jerks for a plethora of reasons and it's not necessarily academically related.
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There are definitely jerks out there. However given OPs story of already quitting one residency and apparently conceding he didn't do well will the pimp questions, I think it's harder to assume that's what this was. And there's a world of difference between a marginal evaluation and being asked to resign.
OP, sorry that this happened to you. What a painful situation to be in. The fact you had to repeat the rotation with the same attending doesn't seem right. Was he literally the only one who gave you poor evaluations the entire year? If so, if that was actually the case, that really doesn't seem fair. I imagine others attendings might have been similarly concerned but didn't express it openly or in evaluations? Even if it's just for procedural/legal reasons, seeing as you didn't do anything egregious, you'd think they'd actually want documentation of your deficiencies coming from more than just one attending. Anyway, autopsying this a few years after the fact won't change anything, but I wonder if you could've appealed to GME or something. It does sound like you got a raw deal. What's done is done though, and unfortunately, this was the second residency you didn't complete.
What have you been doing for the last few years? Have you done anything clinically related, volunteering, etc.? How bad do you still want to do medicine? You're in a tough position and I wouldn't want to give false hope but it would seem that the only way to potentially get another spot would be to stay clinically active somehow (i.e. aggressively volunteering at a free clinic or something like that?), working on your skills/knowledge, and see if you can get new LORs/meet attendings that would be able to provide some guidance; it's probably a long shot, but that would seem to be the only reasonable route if you're still motivated. Were there any attendings at the program that liked you/gave you good evals who you could talk to? Simply applying again and again while not doing anything medical and without new LORs/connections doesn't seem like it would be fruitful. You need new people to back you up moving forward. Also, what specialties have you been applying to? Only FM? Have you tried applying very very broadly to psych?
Otherwise, there are still other interesting careers out there that your MD would open some doors for, and sometimes you have just have to cut your losses and move forward with life.
What have you been doing for the last few years? Have you done anything clinically related, volunteering, etc.? How bad do you still want to do medicine? You're in a tough position and I wouldn't want to give false hope but it would seem that the only way to potentially get another spot would be to stay clinically active somehow (i.e. aggressively volunteering at a free clinic or something like that?), working on your skills/knowledge, and see if you can get new LORs/meet attendings that would be able to provide some guidance; it's probably a long shot, but that would seem to be the only reasonable route if you're still motivated. Were there any attendings at the program that liked you/gave you good evals who you could talk to? Simply applying again and again while not doing anything medical and without new LORs/connections doesn't seem like it would be fruitful. You need new people to back you up moving forward. Also, what specialties have you been applying to? Only FM? Have you tried applying very very broadly to psych?
Otherwise, there are still other interesting careers out there that your MD would open some doors for, and sometimes you have just have to cut your losses and move forward with life.
@Law2Doc
I agree that I had made some mistakes but I can assure you that all residents make mistakes in their intern years. You seem to jump to conclusions that everything is purely academic performance. For example, what if someone had slept with the daughter of the attending? What then? There are residents who have matched 4 times, albeit for different reasons. I agree with lostin_space and Brick Majors for their thoughts and frankly speaking, a resident can be fired at any time, for any reason or for no reason at all. If some incoming residents are so great, they wouldn't need to sign a yearly agreement. Instead, they could have be given a 3-year agreement at the start of residency for their stellar records. I know another resident who was fired in the 11th month of her intern year. I know I was not the best resident in my program. Even if I were the best or worst, it still would not change the scenario. Not all attendings think alike, that there some people who might not like you necessarily for your last name, ethnicity, skin color, body habitus, accent, smell, or anything else. This is human nature. FYI, I resigned from the first program for health reasons and not for academic.
I agree that I had made some mistakes but I can assure you that all residents make mistakes in their intern years. You seem to jump to conclusions that everything is purely academic performance. For example, what if someone had slept with the daughter of the attending? What then? There are residents who have matched 4 times, albeit for different reasons. I agree with lostin_space and Brick Majors for their thoughts and frankly speaking, a resident can be fired at any time, for any reason or for no reason at all. If some incoming residents are so great, they wouldn't need to sign a yearly agreement. Instead, they could have be given a 3-year agreement at the start of residency for their stellar records. I know another resident who was fired in the 11th month of her intern year. I know I was not the best resident in my program. Even if I were the best or worst, it still would not change the scenario. Not all attendings think alike, that there some people who might not like you necessarily for your last name, ethnicity, skin color, body habitus, accent, smell, or anything else. This is human nature. FYI, I resigned from the first program for health reasons and not for academic.
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I don't mean to pile on, but resigning after one week in an intern year of a program wouldn't be academic of course. You didn't give it enough time to see if academic problems would surface or not. Now as far as health reasons, I find it odd that you'd go through a program that you would know is going to cause issues...
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OP, you aren't getting any help here because no one can help you. Its time to move on. Possible options would include nursing, PA school or leaving health care altogether. There is almost no chance you'll get another internship now. It really doesn't matter if its fair. You left two programs on bad terms. You went to an offshore school. There just aren't programs that need to take an applicant like that (there will always be better) so unless you have some connections to leverage that you didn't use before now, its over.
For other folks reading this thread, as soon as the repeat OB rotation was going poorly, OP needed to go to his PD and ask for a different proctor.
For other folks reading this thread, as soon as the repeat OB rotation was going poorly, OP needed to go to his PD and ask for a different proctor.
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There are some bad attendings out there, as well as some residents who don't meet expectations. It's hard to parse out what's going on here. But the fact that you bailed on an initial residency in a week because you "could not keep up" tilts the scales one direction. (Although you now claim it was "health reasons" rather than pace). But it doesn't really matter. You had two bites at the apple. Time to figure out a plan B.
QofQuimica
Seriously, dude, I think you're overreacting....
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Agree with the others that it's time to move on, OP. Unfortunately you had your multiple chances, and you blew them. There aren't a lot of second chances in medicine, let alone third chances. Asking for a fourth chance is really too much. I suggest that you take the highest-paying job you can find and start paying back your loans as best you can. I'm sorry it didn't work out for you.
I had one attending in residency whom I didn't gel with too. My whole intern year and into the start of my second year, this guy was constantly in my face. The thing was, he was often right in his criticisms of me, even if he wasn't all touchy-feely with how he let me know about it. And while I didn't particularly enjoy his teaching style, I did learn something and get better because of it. And then one day after he and I finally had it out because he was WRONG about something he was criticizing me for and I knew it, that was the day when he finally backed off. It's like he was waiting for me to reach that point.
I don't know why some attendings feel like they have to teach like that. I guess it's just what they know from their own training days. And it's all water under the bridge now anyway, for both of us. But FWIW, your being "mellow" may have seemed like a weakness to your OB attending, not a strength. He might have respected you (and your knowledge base) more if you were more assertive. I don't mean that you should have been disrespectful; I mean knowing your stuff well enough to be able to stand your ground with him and defend your clinical decisions.
I had one attending in residency whom I didn't gel with too. My whole intern year and into the start of my second year, this guy was constantly in my face. The thing was, he was often right in his criticisms of me, even if he wasn't all touchy-feely with how he let me know about it. And while I didn't particularly enjoy his teaching style, I did learn something and get better because of it. And then one day after he and I finally had it out because he was WRONG about something he was criticizing me for and I knew it, that was the day when he finally backed off. It's like he was waiting for me to reach that point.
I don't know why some attendings feel like they have to teach like that. I guess it's just what they know from their own training days. And it's all water under the bridge now anyway, for both of us. But FWIW, your being "mellow" may have seemed like a weakness to your OB attending, not a strength. He might have respected you (and your knowledge base) more if you were more assertive. I don't mean that you should have been disrespectful; I mean knowing your stuff well enough to be able to stand your ground with him and defend your clinical decisions.
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Question:
Is this really how it works in US residency, that basically "one" bad rotation/evaluation by "one" attending can get you fired? Seems extremely arbitrary!!
Is this really how it works in US residency, that basically "one" bad rotation/evaluation by "one" attending can get you fired? Seems extremely arbitrary!!
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We are only getting one side of the story here...
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Here's my read of this situation:
Just like medical school, most positions, whether faculty, post-doctoral fellowships, or residency, invest a lot of effort to keep people rather than getting rid of people.
Being a dad, there are always two sides to every story.
When dealing with failing students in any capacity, there is a "tip of the iceberg" phenomenon. Meaning, one single thing doesn't get you fired...it's a series of events. Being poor at being pimped is not not likely to get one fired.
Just like medical school, most positions, whether faculty, post-doctoral fellowships, or residency, invest a lot of effort to keep people rather than getting rid of people.
Being a dad, there are always two sides to every story.
When dealing with failing students in any capacity, there is a "tip of the iceberg" phenomenon. Meaning, one single thing doesn't get you fired...it's a series of events. Being poor at being pimped is not not likely to get one fired.
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It varies somewhat from field to field but overall 95%+ of residents graduate the first residency they start. The vast majority of those never had any issues with probation, even though most likely had at least one bad evaluation over their 3-7 years.
We see many of the exceptions here, because no one posts about their succesful completion of residency without issue.
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Sure - It would be narcissistic to start a thread on SDN to boast that you completed residency without issue. But those people on SDN who are attendings and fellows all somehow got through.
Most of us know "a" person who had issues. A smaller few of us know 2. It's rare -- programs don't throw people out just because one attendings feathers got ruffled. Most programs have pretty extensive remediation and probation systems, whereby people meet with the PD or an advisor and are advised what expectations they aren't meeting and are given second or third chances to right the boat.
But even so, we all know that one resident that doesn't "get it". A guy who continues to insist he's doing everything his co-residents are doing and just as well, even after attendings or the PD or Chiefs sit the guy down and tell him that's unfortunately not the case. Or the guy who is awful on service but thinks his inservice scores should somehow count for something more. Sorry, but if you can't be trusted with the service alone overnight attendings couldn't care less how you do on multiple choice tests.
Residency is a lot of work but (having worked in another field) it's really not that hard a job. You need to show up early, leave late, have a good roll-up-your-sleeves attitude, be a good team player and try to anticipate what your attendings are going to want from you when you talk to them. Things like test scores are simply less important.
In truth it's kind of like being in the army. Radar O'Reilly of the old MASH series would have been a good resident, always right there when his boss needed something, always anticipating what Colonel Blake/Potter wanted and handing them the appropriate paperwork to sign or getting HQ on the phone even before he asked for it.
You've got to play the game -- and it is a game, albeit a high stakes one. I don't think I have ever been the most gifted resident in my year, but I've gotten good evaluations from attendings by insisting on staying late even when they told me I could go, or being quick to volunteer for things I really wouldn't have minded skipping, or willingly taken on more responsibilities. I don't think I ever focused on whether I was doing as much or as well as my co-residents, and I suspect those who focus on those things subconsciously have reason to worry about such things.
Anyway, while I think OP may need to find something else, his tale isn't really that much of a cautionary one. He got second chances in terms of matching into s residency and then another second or third chance to remediate things while on probation. He feels the decks were set against him but he might feel that whether it was true or not. Most of those reading this thread will do fine and thrive and perhaps may even someday "know a guy" who didn't make it through. But it simply won't be you if you resolve that this is going to be your life for the next X years and grin and soldier through.
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no it doesn't...the one attending may have been vocal, but i doubt the PD and the progression committee may have known that similar feelings were felt by others in the program. By his own admission he WAS given another chance (put on probation) and he failed to show them that he had improved .
QofQuimica
Seriously, dude, I think you're overreacting....
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Having been on both sides of the system (first as a resident, now as an attending), I'd be the last person to argue that there is no subjectivity whatsoever to the evaluation system. And sometimes, it's understandable how an outsider could come away from reading this forum with the impression that all the programs in this country are full of vindictive, horrible PDs and attendings who are skulking about in dark alleys, just waiting to stab their knives into the back of the first helpless, innocent baby kitten of a resident who accidentally wanders in off the well-lit beaten path. That being said, no, it's not true that this is how things actually go down. Don't get me wrong: one bad rotation or evaluation by one attending may indeed get someone fired from residency. But if it does, that's because that one bad rotation or evaluation by that one attending was the final straw in a string of bad rotations/evaluations by other attendings that finally forced things to come to a head. Somehow, many of the posters here neglect to mention the prior history of problems until questioned, and then it all starts to come out.
To be honest, I'm still trying to wrap my head around how the OP was unable to keep up in his first program to the point that he resigned in the first week. I've never heard of anyone dropping out of residency that fast. At my program, we weren't even through with orientation yet after one week....
Yeah its a bit hard to wrap your head around...when it stuck in your rear end. One has to wonder why they can smell the *#*# but not fully comprehend it.
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Please keep your posts respectful and professional. Personal attacks are not tolerated, either.
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I suspect its easier to understand after this post.
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This reminds me of my first attending as an intern telling me "just be quiet and listen, in time the patient will reveal their pathology."
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Oh, I agree. I've seen an intern or two like what you're describing...in fact I have one now on my service. She's an 11th month intern that literally works and acts like a 1st month intern (and a crappy 1st month intern, at that). She's extremely inefficient, stumbles while presenting patients, has seriously subpar medical knowledge, misses things, forgets orders, can't talk smoothly with patients, etc. It's ugly. I have a really good 3rd year medical student on the service and the student is frankly better than she is. That's really, really bad news. She also shows zero insight...she gets there late and doesn't get everyone seen by rounds. I basically have to babysit her and run her patients for her because she's so incompetent...I could basically tell her to go home and it might actually SAVE me time. There was one day where I literally wrote all her follow-up notes and admitted two patients in the amount of time it took her to admit one patient (which was the only work she completed for the day). The chiefs are aware and say I'm hardly the first one to bring up things like this about her.
These are the types of people who will find themselves in the 'danger zone' in terms of getting put on probation or canned. Not 'above average' or even 'average' housestaff. Ya gotta stick out like a sore thumb. Granted, there are harsher programs out there than ours (our PD is extremely laid back) where some PD could make someone's life miserable for the hell of it, but I really think this is pretty uncommon.
QofQuimica
Seriously, dude, I think you're overreacting....
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The one resident who got canned where I knew all the details of the "final event" totally deserved it. I was the MICU night senior at the time. Dude on probation was repeating his intern MICU rotation after failing it once, and he didn't show up one night. Left that morning like usual and then didn't show up for work that evening. Didn't call anyone to tell them he wasn't coming. Just no-showed. I didn't even report him to the chiefs (because frankly, I was pretty fed up with him myself by this point.) Unfortunately, one of the chiefs came by to see how things were going for us, and then I had to confess that, oh, um, yeah, he kinda didn't show up. So he got fired, and some poor intern on a subspecialty month got pulled off to cover the rest of his MICU shifts, which I felt bad about. But I sure didn't feel bad for the guy they fired. 
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The one resident who got canned where I knew all the details of the "final event" totally deserved it. I was the MICU night senior at the time. Dude on probation was repeating his intern MICU rotation after failing it once, and he didn't show up one night. Left that morning like usual and then didn't show up for work that evening. Didn't call anyone to tell them he wasn't coming. Just no-showed. I didn't even report him to the chiefs (because frankly, I was pretty fed up with him myself by this point.) Unfortunately, one of the chiefs came by to see how things were going for us, and then I had to confess that, oh, um, yeah, he kinda didn't show up. So he got fired, and some poor intern on a subspecialty month got pulled off to cover the rest of his MICU shifts, which I felt bad about. But I sure didn't feel bad for the guy they fired.
Did he think no one would notice? Amazing that people could engage in such self-sabotaging behaviors unless you get loaded or something and slept through the shift? Boring yet more likely explanation I guess.
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The one resident who got canned where I knew all the details of the "final event" totally deserved it. I was the MICU night senior at the time. Dude on probation was repeating his intern MICU rotation after failing it once, and he didn't show up one night. Left that morning like usual and then didn't show up for work that evening. Didn't call anyone to tell them he wasn't coming. Just no-showed. I didn't even report him to the chiefs (because frankly, I was pretty fed up with him myself by this point.) Unfortunately, one of the chiefs came by to see how things were going for us, and then I had to confess that, oh, um, yeah, he kinda didn't show up. So he got fired, and some poor intern on a subspecialty month got pulled off to cover the rest of his MICU shifts, which I felt bad about. But I sure didn't feel bad for the guy they fired.
Did you page him when he didn't show up?
QofQuimica
Seriously, dude, I think you're overreacting....
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No idea. I never saw him again.
I don't remember now, but I don't think so. I wasn't exactly sorry that he hadn't shown up once I made sure he wasn't physically ill or injured.
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I can think of a small handful of times in residency someone overslept or misread the schedule and didn't realize they had to come in (more common with random night shifts actually)... but generally the outcoming person texts/calls/pages them. If they never respond, then a call goes to the chief on call (perhaps an hour later). The thing is though, no one made a habit of that sort of thing and no one got fired for it. It happens.
That said, I can imagine that if a resident was already on the border that something like the above circumstance can be the straw that breaks the camel's back. Especially if the resident was on the border for something like a substance issue, because it would be very suspicious. We had a thread a while back about someone in exactly such a circumstance.
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As someone in a relatively good program who was put on "watch list", I can relate to the OP. And every thing that has been stated is true. The fact you were singled-out shows that you aren't as strong as you think. You were probably viewed as a "weak link" and had to be scrutinized. However, it's your prerogative to step up or get kicked out.
I was viewed as weak last year. Unfairly if you ask me. It's not my fault my first rotation on gen med/floors was October. And one particularly persnickety attending weeded me out my 1st week. Stating I was clearly not up to par w/ my colleagues, despite the fact I tried to reinforce it was only my first week on floors. Regardless I was put on the "watch list". But I don't know. Maybe because I felt more angry and offended that I was being unfairly compared to peers who had already done floors, I got my s*** together. Albeit I had more electives so my 2nd month of floors was December, and NOW I was being compared as a 1/2 year intern as opposed to a 2-months of floors/gen med intern.
That all said, I stayed on that damn watch list just about til contract time. My PD told me that I was very suspect for promotion. However, I've been doing so well on floors, there was no question when contracts were sent out I got one! And hell yeah, I signed it. In fact, prior to contracts going out, one of my toughest critics was my attending, and I wow'd the s*** out of her, so much so she actually gave me a "blessing" and told me to keep it up as a PGY-2. (She actually sub'd for my attending on my 1st month of floors and called the chiefs and my PD to tell them I wasn't operating at a level I should in mid-October) So it is really refreshing she advocated for me to make sure I was promoted when it was time for contracts.
The eval process can lean towards being subjective, however, these subjective ratings are peer-based, and usually made by people who have seen class after class of residents so their subjective evals tend to have a hint of objectivity to them. Sometimes it can be the competency review board asking an attending: "Would you let this resident care for your family member?" or in your case "Deliver your baby?"
I don't know what else to say. I was put in a similar spot. But I got my s*** together (or at least got enough experience as my peers to mitigate my circumstances) and as I said basically wow'd one of my harshest critics. No matter what, you were given a chance to do the same, and for whatever reason, you were unable to rise to the occasion.
I was viewed as weak last year. Unfairly if you ask me. It's not my fault my first rotation on gen med/floors was October. And one particularly persnickety attending weeded me out my 1st week. Stating I was clearly not up to par w/ my colleagues, despite the fact I tried to reinforce it was only my first week on floors. Regardless I was put on the "watch list". But I don't know. Maybe because I felt more angry and offended that I was being unfairly compared to peers who had already done floors, I got my s*** together. Albeit I had more electives so my 2nd month of floors was December, and NOW I was being compared as a 1/2 year intern as opposed to a 2-months of floors/gen med intern.
That all said, I stayed on that damn watch list just about til contract time. My PD told me that I was very suspect for promotion. However, I've been doing so well on floors, there was no question when contracts were sent out I got one! And hell yeah, I signed it. In fact, prior to contracts going out, one of my toughest critics was my attending, and I wow'd the s*** out of her, so much so she actually gave me a "blessing" and told me to keep it up as a PGY-2. (She actually sub'd for my attending on my 1st month of floors and called the chiefs and my PD to tell them I wasn't operating at a level I should in mid-October) So it is really refreshing she advocated for me to make sure I was promoted when it was time for contracts.
The eval process can lean towards being subjective, however, these subjective ratings are peer-based, and usually made by people who have seen class after class of residents so their subjective evals tend to have a hint of objectivity to them. Sometimes it can be the competency review board asking an attending: "Would you let this resident care for your family member?" or in your case "Deliver your baby?"
I don't know what else to say. I was put in a similar spot. But I got my s*** together (or at least got enough experience as my peers to mitigate my circumstances) and as I said basically wow'd one of my harshest critics. No matter what, you were given a chance to do the same, and for whatever reason, you were unable to rise to the occasion.
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Stories like this are just so awful. For all the fear that gets drummed up on these forums about getting canned, very few people are willing/able to delineate the actual due process of a resident getting fired. I've heard "oh, it takes a lot," "the red tape is ridiculous," etc. Can anyone actually describe the details other than the fact that the resident in question most likely would have to be put on formal probation first?
QofQuimica
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It's going to be hard to answer your question with specifics because each case is unique. And a lot depends on what else is going on regarding job performance and professionalism issues with that resident. A resident who has a lot of issues in different areas with several different faculty is not going to fare well compared to someone who is generally doing well but maybe has one area of weakness and is otherwise well-liked. Bear in mind that the stories you read here are necessarily one-sided and usually skewed heavily toward exonerating the resident of any responsibility for their situation. And unfortunately, in many cases, a major part of the fired resident's problem is that they didn't have the insight to recognize that they needed to step up their game when they were told their performance was subpar. Go back and reread the first post in this thread again, and then reread Gflip's post above yours. The difference in attitude and sense of personal responsibility really jumps out at you when you read them back to back.
I posted earlier in this thread about how a specific attending thought my performance was subpar during my intern year also. While I didn't exactly like the guy, I could at least recognize that his intention in being so rough on me was to motivate me to step up my game, not to abuse me. The reason why I avoided failing a rotation, being put on probation, or getting fired is because, like Gflip, my response to his "extra attention" was to learn from his criticism, then work harder to reach the performance level he wanted me at. And once he was satisfied that I had gotten there, that was when he backed off.
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There is no universal standard, and no outside agency enforces any kind of due process for residents. The financial incentives lean heavily towards retaining residents: the government pays 100% of a resident's salary and 70K of what is effectively tuition besides, and its almost impossible to replace a resident who is fired, so the loss of a resident means the loss of both income and free labor for the program until that resident's class graduates. For most programs that means many, many second chances and official notifications, moving through a period of formal probation prior to actual termination.
However if you going to believe that residents are at the bottom of their classes for a reason, you also have to believe that residencies are bottom tier for a reason. Arbitrary and capricious disciplinary decisions are a common theme among residencies that are taking their residents from SOAP. This leads to a situation that's difficult to interpret: the residents who are the most likely to present cause for termination tend to match at the programs most likely to terminate them without reasonable cause.
I agree with the OP that any program that forces a resident to remediate a failure with the attending that already failed them is not giving them an adequate opportunity to show improvement.
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This is a fair point; I trained at an academic program and work now for another one that both fill with US seniors through the match, so my experience is biased because of that.
But I would make the opposite argument here. In the same way that continuity of care is good for patients because the same HCP who has cared for them in the past is generally in the best position to assess the progression of their illness over time, an attending who has worked with a specific resident before is often in a better position to judge that resident's ongoing progress than someone who has never worked with them before. This is of course assuming that the attending is truly not out to "get" the resident. In a situation where there is concern for bias against the resident on the part of the original attending, maybe the best solution would be a mix of the two (i.e., half the rotation with the original attending and half with a new one). Then the resident would get the benefit of feedback from multiple attendings, and the PD would get multiple perspectives on the resident's performance.
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EXACTLY!
Being under a microscope really puts pressure on you. And I know it sucks. When the chief of medicine is being told to read your discharge summaries or randomly go through your sign-outs, it's pressure that either breaks your or makes you stronger! I took every single criticism and "used it against them" in a positive way. If I was told: "You should know how to handle a GI bleed by now" I made sure not only that I could, but could (what I believed) better than my peers. As far as I know, I'm one of the few interns who NEVER had to be told to order an INR the day of the upper/lower. Because I knew the GI docs really don't like scoping patients w/ INR's >1.7 and if the AM lab was above that I already ordered the FFP and the repeat INR 2 hrs before the anticipated time. At 9am rounds, not only could I say all of that, but my attending could look in the EMR and see I ordered all of that at 7am.
If I was told my knowledge was lacking, not only did I check Uptodate when I got home, I read what I could in Harrison's w/ all of that detail so that I could maybe bring it up the next day, discuss some of the pathophys gleaned from Harrison's, discuss guidelines, studies, etc. If I was told my discharge instructions were lacking, the next one was more than adequate. Then I became "excessively thorough", but that was never faulted.
If being spiteful made me a better resident, so be it. But again, I realized criticism and harshness was based out of some element worth addressing. The fact that I just finished floors and my attending basically started leapfrogging my resident to me was reassuring. After all I was being scrutinized as to whether I could be a PGY-2, in particular by a woman who months and months ago thought I was borderline incompetent!
Maybe it happens in "malignant" programs, but all in all, it is a detriment to a program to kick someone out. I understand how much it sucks to go through, but I also acknowledge the best interest of the program is to help marginal residents succeed. It's NOT to single someone out to make them fail. That benefits no one. In fact, it only adds strain to the rest of the residents. It's not even useful to say, "Oh that intern has worse sign-outs than me, why isn't she being asked to talk to the chiefs or see the PD!?" Regardless of my opinion of myself, it matters more the opinion of the folks who make the important decisions.
I don't. Again, if spite made me better so be it. But I actually welcomed having an attending who PIMP'd the hell out of me and also reported me to the chiefs and PD in October be my actual attending. And have it turn around to her really "loving" me to the point she was disappointed I was changing service because I proved my I's were dotted and my T's were crossed day after day w/ her. She thought it was funny/amusing that I was confident enough to "argue" w/ her at rounds. The dichotomy of the team was almost uncomfortable. She'd yell at my co. She'd yell at the resident. Then joke and smile w/ me. The ability to in essence say: "I told you so!" is f***ing awesome!
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As I've said above attitude is huge. If you show up on time with admire on your face, work hard, promptly answer your pages, know your stuff reasonably well, be congenial (never argumentative), never lie about doing things you didn't, and be a good team player you'll be fine. That's it.
If you show up habitually late, constantly complain about hours or workload, ask seniors to step in and help you more than once, feel the need to assure yourself you are doing just as well as your co-residents, or that you are doing great because of a high inservice score which you think must count for something, you might be on thinner ice.
If you show up habitually late, constantly complain about hours or workload, ask seniors to step in and help you more than once, feel the need to assure yourself you are doing just as well as your co-residents, or that you are doing great because of a high inservice score which you think must count for something, you might be on thinner ice.
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I got asked about this in a PM, so I thought I'd share it here:
It's rarely seen in the MD world anymore, but many DO programs have been know to "pyramid" their residents where they make take in 7, promote 5 or 6 to 2nd year, promote 4 to 3rd year and so on. It's very obvious that the program is firing one to two residents per year by looking at the stats and seeing a similar pattern. Looking at their benefits plans and confirming them with their HR will also open your eyes to if they are misrepresenting them or not. If they are, even a little bit, the program is unlikely to tell you the truth about how malicious the program could be. You'll want to ask around what other students you know that are in the area around a certain program think of it if they've done so recently. If the residents always look sad, angry or stressed out, you definitely don't want to be at any program at that hospital. Last, but not least, see how many hours, on average, per month the residents under report their hours. The ACGME just has to spend an hour in HR looking through the logs or cameras to see when people are coming and going or look at how long they work from home every day, and the program that you might join will be on probation for most of the time you're there. DO residencies pay much less and have next to no benefits than their MD neighbors do, so don't sign up to be on the chopping block right as you start working there!
There are still many malignant programs out there, so let's keep up the good work with reporting them here! At least we'll only have one system to watch out for soon!
It's rarely seen in the MD world anymore, but many DO programs have been know to "pyramid" their residents where they make take in 7, promote 5 or 6 to 2nd year, promote 4 to 3rd year and so on. It's very obvious that the program is firing one to two residents per year by looking at the stats and seeing a similar pattern. Looking at their benefits plans and confirming them with their HR will also open your eyes to if they are misrepresenting them or not. If they are, even a little bit, the program is unlikely to tell you the truth about how malicious the program could be. You'll want to ask around what other students you know that are in the area around a certain program think of it if they've done so recently. If the residents always look sad, angry or stressed out, you definitely don't want to be at any program at that hospital. Last, but not least, see how many hours, on average, per month the residents under report their hours. The ACGME just has to spend an hour in HR looking through the logs or cameras to see when people are coming and going or look at how long they work from home every day, and the program that you might join will be on probation for most of the time you're there. DO residencies pay much less and have next to no benefits than their MD neighbors do, so don't sign up to be on the chopping block right as you start working there!
There are still many malignant programs out there, so let's keep up the good work with reporting them here! At least we'll only have one system to watch out for soon!
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It's so rare, that it doesn't exist. Pyramidal programs are forbidden by the ACGME, and have been for many years.
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So, because the ACGME or the AOA programs soon transitioned in under it say something isn't allowed, it absolutely can't happen? I'll have to think about that.
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I've said that some AOA programs sound like the wild west. The ones that now are pyramidal, if they continue in this fashion, will find a quite rude awakening.
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A program that consistently loses residents will likely get a long, hard look by the ACGME and closed down if they can't improve their retention.
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I'm so looking forward to that rude awakening coming! It will probably take place years from now when the ACGME forces the residency programs to start putting MD program directors in charge of the DO programs. Then gets rid of the COMLEX....HA HA HA!
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Good luck with getting rid of COMLEX, given its written into various state laws. The licensing boards give no f---ks what the program directors say on the matter.
I'm not sure why alot of people on this thread are being somewhat mean to you. There's definitely asshat attendings and I'm sorry that essentially 1 person was able to end your medical career. Please post their name so that others can be aware of who this asshat is. In terms of your future medicine prospects: one option is apply to be a physician in other countries like Australia. I've heard that it's not too difficult to become a primary care doc in the non-metro areas there. Other options include doing research at an internal medicine department that accepts IMGs, buddying up with the program director and chair and getting accepted to their program. Both of these involve quite a bit of time investment. I wish you the best of luck.
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The one being mean to OP here is you, as you seem to want him to compound his issue by inviting a libel lawsuit to boot. Bad idea.
There are definitely some bad attendings out there, but the number who make it their business to ruin someone's career without reason borders on zero, and as mentioned programs have big incentives, both financial and for staffing reasons, to not fail out their residents without reason. OP has documented enough missteps in just his own posts (and of course there's a whole other side of the story) that it's really not a stretch to think they dug their own grave here. The non-mean posts are thus those that suggest a plan B. The mean posts are those suggesting OP should incur liability naming names and to toil further to try for yet a third/fourth chance.
Wow you know the ~100,000 attending physicians out there?
Law2Doc are you an internal medicine doc?
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Wow you know the ~100,000 attending physicians out there?
Law2Doc are you an internal medicine doc?
seriously, you decide to champion a guy who quit his surgery prelim spot ONE WEEK into it cuz it was "too hard" for him and then was effectively fired from his second residency??
we have ALL had "that attending" the one that seemingly picks on an intern or resident...and guess what? the way you fix it is by stepping up to the plate and show them you are willing to learn, that you are willing to take the criticism and that you improve...
and L2D doesn't have to KNOW every attending out there to know that that most teaching attendings are not looking to be "mean" to interns and residents...these are people who choose to be in academics instead of pp..making less money and dealing with the politics of academia to do so...but i'm sure it annoys some of them when the intern or resident shows little to no interest in listening to constructive criticism or acting on advice to improve...or evidently doesn't realize the seriousness of being placed on probation.
