Impending Probation- worried..

[Sme611]

Hi i'm a current intern and almost half way into the year things started taking a turn and escalating for worse. It started when several months into the year I began a new rotation that was more challenging, it took me time to get the hang of things but I felt I adjusted well and improved overall. Despite this I ended up failing that rotation even though I put in a lot of effort and felt I was learning as an intern. It seems tough there was some bias or false remarks from another resident that led to this, but were out of my control. Fast forward I failed other consecutive rotations, which seemed was a domino effect- and possibly related to the fact that I failed my first rotation. I have been trying really hard and told I had improved but seems it's hard to recover from the downfall and added stress from everything that's been going on. Now i'm advised the next step is probation. I'm really nervous as I came this far in life ( as the rest of us have) , despite doing well until now ie medical school, boards etc.

I'm looking for any advice or help from anyone that has experience in a similar situation.

There are ovbiously more details but left them out to remain anonymous and just posted a general picture.

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[deleted480308]

I think the magnifying glass is real. You might be “ that” resident now.

Can you describe your actual deficiency? Do you know what the metric is for staff to call that fixed? Any personality problems with anyone? Any basic adulting problem (late for things, dragging on notes, missing meetings/didactic)?

 

[Sme611]

I think the magnifying glass is real. You might be “ that” resident now.

Can you describe your actual deficiency? Do you know what the metric is for staff to call that fixed? Any personality problems with anyone? Any basic adulting problem (late for things, dragging on notes, missing meetings/didactic)?

You mean the resident on the spot light as if being picked on?

No personality problems with anyone so far or coming late, or issues with professionalism etc.

More performance issues -which I agree, I have a lot of room to improve and could do better ( even though I felt i have come a long way, have improved and told so) but still they're finding that i'm failing and finding me deficient. It seems like a cycle that's hard to overcome and might be as well due to a combination of rotation/attendings etc.

 

[deleted480308]

You mean the resident on the spot light as if being picked on?

No personality problems with anyone so far or coming late, or issues with professionalism etc.

More performance issues -which I agree, I have a lot of room to improve and could do better ( even though I felt i have come a long way, have improved and told so) but still they're finding that i'm failing and finding me deficient. It seems like a cycle that's hard to overcome and might be as well due to a combination of rotation/attendings etc.

I mean the resident the attendings know is struggling so they pick up on mistakes more. It can be hard to dig out of since you've failed multiple rotations

What do you need to do better and how will attendings judge that?

 

[BoardingDoc]

It seems tough there was some bias or false remarks from another resident that led to this, but were out of my control. Fast forward I failed other consecutive rotations...

Whether you actually had a different resident affecting your performance reviews or not, this is not something which you can afford to be focused on. Figure out what your weaknesses are and work on concrete plans to improve them. Assuming that you are being targeted by some external force and set up to fail is distracting at best, and a manufactured explanation for personal deficiencies at worst.

 

[hallowmann]

...More performance issues -which I agree, I have a lot of room to improve and could do better ( even though I felt i have come a long way, have improved and told so) but still they're finding that i'm failing and finding me deficient. It seems like a cycle that's hard to overcome and might be as well due to a combination of rotation/attendings etc.

You need to stop attributing this to external factors and focus on the internal performance issues. Obviously if you're failing despite improvement, then that means you aren't improving at the same rate as the other residents. Other residents have combinations of rotations and attendings that make excelling difficult too, but they're still passing.

I would go out of my way to find out exactly how/where you can improve on every rotation. Talk to your attendings and seniors on the service every week at least and see if there's some advice they can give you to improve your performance. Is it an efficiency thing? Is it a formulating a plan thing? etc. You then have to actually implement changes to those areas that they can see.

Another thing you need to keep in mind is that a big part of residency is your ability to adapt. Adapt to different situations, rotations, and how attendings do things. If a specific attending likes orders or presentations done a certain way, you need to learn that way and do it. Its unfortunate, because those things don't necessarily mean its the "right way", because there are typically multiple right ways to do things in medicine, but its the "right way" with that attending, that rotation, or that team.

Another thing you should try to do is to communicate with other residents regarding upcoming rotations. You need to get the details about upcoming rotations so that you know at least a little bit of the workflow, expectations, and what's important. This can go a long way to help you start at a better position in each new rotation.

 

[ThoracicGuy]

You need to stop attributing this to external factors and focus on the internal performance issues. Obviously if you're failing despite improvement, then that means you aren't improving at the same rate as the other residents. Other residents have combinations of rotations and attendings that make excelling difficult too, but they're still passing.

I would go out of my way to find out exactly how/where you can improve on every rotation. Talk to your attendings and seniors on the service every week at least and see if there's some advice they can give you to improve your performance. Is it an efficiency thing? Is it a formulating a plan thing? etc. You then have to actually implement changes to those areas that they can see.

Another thing you need to keep in mind is that a big part of residency is your ability to adapt. Adapt to different situations, rotations, and how attendings do things. If a specific attending likes orders or presentations done a certain way, you need to learn that way and do it. Its unfortunate, because those things don't necessarily mean its the "right way", because there are typically multiple right ways to do things in medicine, but its the "right way" with that attending, that rotation, or that team.

Another thing you should try to do is to communicate with other residents regarding upcoming rotations. You need to get the details about upcoming rotations so that you know at least a little bit of the workflow, expectations, and what's important. This can go a long way to help you start at a better position in each new rotation.

I agree with everything here, @Sme611.

This biggest things you need to do are accept the criticism without trying to blame anyone else. Yeah, it probably feels like outside factors are contributing with some of your issues and perhaps there is some influence, but ultimately it comes down to you and how you deal with it.

Feedback is also critically important. You may find some residents and attendings are difficult to obtain feedback. Giving constructive criticism can be hard for some physicians. If you can find a mentor, either a senior level resident or one of your attendings, that can be very helpful. You want them to cut through all the crap and let you know how it really is and what they think you can do to help.

You need to focus on improving yourself each day. You want your colleagues to see you are actively improving. Be the first one there and the last to leave (without going over your hours). Don't be on your phone, even if it's just to look something up. You don't want to give any impressions that you are into anything but medicine and your patients. Don't be caught sitting around. If you don't have anything to do, find what else the team needs to be done. There is always something to be done. Make a checklist so that you can ensure all of the team's plans are implemented. Don't be afraid to ask for help, but don't use it to dump work on others that you don't want to do.

While different specialties have different requirements and tasks, these things are pretty universal.

Good luck.

 

[rokshana]

I agree with everything here, @Sme611.

This biggest things you need to do are accept the criticism without trying to blame anyone else. Yeah, it probably feels like outside factors are contributing with some of your issues and perhaps there is some influence, but ultimately it comes down to you and how you deal with it.

Feedback is also critically important. You may find some residents and attendings are difficult to obtain feedback. Giving constructive criticism can be hard for some physicians. If you can find a mentor, either a senior level resident or one of your attendings, that can be very helpful. You want them to cut through all the crap and let you know how it really is and what they think you can do to help.

You need to focus on improving yourself each day. You want your colleagues to see you are actively improving. Be the first one there and the last to leave (without going over your hours). Don't be on your phone, even if it's just to look something up. You don't want to give any impressions that you are into anything but medicine and your patients. Don't be caught sitting around. If you don't have anything to do, find what else the team needs to be done. There is always something to be done. Make a checklist so that you can ensure all of the team's plans are implemented. Don't be afraid to ask for help, but don't use it to dump work on others that you don't want to do.

While different specialties have different requirements and tasks, these things are pretty universal.

Good luck.

Just to reinforce what TG and hallowmann have said...even if you really believe that there are outside forces contributing to your issues, the only thing you have control over are the internal issues...and there ARE internal issues...of you don’t think so, then that is part of the problem.

 

[Piebaldi]

I agree with everything here, @Sme611.

This biggest things you need to do are accept the criticism without trying to blame anyone else. Yeah, it probably feels like outside factors are contributing with some of your issues and perhaps there is some influence, but ultimately it comes down to you and how you deal with it.

Feedback is also critically important. You may find some residents and attendings are difficult to obtain feedback. Giving constructive criticism can be hard for some physicians. If you can find a mentor, either a senior level resident or one of your attendings, that can be very helpful. You want them to cut through all the crap and let you know how it really is and what they think you can do to help.

You need to focus on improving yourself each day. You want your colleagues to see you are actively improving. Be the first one there and the last to leave (without going over your hours). Don't be on your phone, even if it's just to look something up. You don't want to give any impressions that you are into anything but medicine and your patients. Don't be caught sitting around. If you don't have anything to do, find what else the team needs to be done. There is always something to be done. Make a checklist so that you can ensure all of the team's plans are implemented. Don't be afraid to ask for help, but don't use it to dump work on others that you don't want to do.

While different specialties have different requirements and tasks, these things are pretty universal.

Good luck.

I agree with this. I also love your vibrating oranges!

 

[Ironheme]

I also love your vibrating oranges!

Heh, it's been a long day. Had to reread that and scroll up. Lol.

Also, agree with the others, especially with what BoardingDoc wrote:

Assuming that you are being targeted by some external force and set up to fail is distracting at best, and a manufactured explanation for personal deficiencies at worst.

Focus on what you can fix, forget the rest, work hard, head down, show up early, eager to improve, and ask for feedback more frequently than you have been. Listen and don't be defensive when the seniors and attendings are giving you critiques. Thank them. Touch base with them after you think you've improved and see what they think so you can calibrate your personal how-i'm-doing-meter with theirs. Good luck.

 

[J ROD]

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