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Discussion in 'Clinical Rotations' started by concerndstudent, Dec 10, 2008.
I wouldn't say anything. When the neurology board certification process comes around they are likely to make the right determination about his knowledge base.
As far as his medical license, I don't think you're qualified to comment on that if he has somehow gotten a license and you haven't seen anything "concrete," as you put it.
First of all, how do you know he was fired from a psych residency? Sounds like a product of the rumor mill. It could just be that public speaking or teaching medical students makes him nervous. Maybe as an FMG he isn't super-confident with his English skills? You haven't actually seen him give patients substandard care. Not being satisfied with how a resident explained MS to you is not reason to try to get him fired.
Anyway, something doesn't add up here. It seems extremely unlikely that this FMG was fired from a psych residency, is incompetent, and yet still landed a neuro residency at an academic medical center. I recommend you don't do anything that could end up making a fool out of you and damaging your career.
Not much you can do, unfortunately. Right now I'm on family practice, which at our site is like watching a new malpractice case(s) unfold in front of me every day I'm at clinic
If someone in your group is close friends with a senior physician/administrator you could make your opinions known to them in private, to et them know to keep their eyes on the guy, but otherwise you can't say anything until the guy actually does something concretely irresponsible. You can go to the attending with 'this guy seems like a friggin idiot'. That won't help the situation and could end badly for you.
Well, s/he obviously passed their usmle steps 1 and 2, so s/he is probably not as incompetent as you make them out to be.
If you are concerned about anything in your clerkship, you need to be speaking with your clerkship director not the state medical board. The state medical board has no say in your education but your clerkship director DOES. Put your concerns in writing as a group and present them professionally and without words like "incompetence" which at your level, you can't judge. There are many things that you don't know completely about this resident. If they were selected to assume a residency position at your hospital, they have the background to do what is expected of them. They just might not be a great teacher or lecturer.
You might also try to assist this person with their presentation skills too. Sometimes the cure for the situation is to step up your game and take charge of the learning yourself. You can ask this person to bring cases (more useful than a straght lecture) and discuss them with you in terms of treatment. Straight lectures during clerkships are a curse of death. Also, sometimes a person who isn't a good lecturer is a great discussion leader.
Your last resort is: Big Harrison's or Big Cecil's. Both of these books give you plenty of information. Ask specific questions about the things that you don't understand. Find review articles (Medline) about some of the newer treatments for a particular disease or condition and discuss why the newer treatements are better (or worse) than gold standard therapy. Ask one of your attendings to sit in on these sessions.
In short, be proactive about what you need to learn so that you can make a good situation out of a bad one. It's your education and you need to get every tuition dollar's worth of learning and experience out of this.
Agree with njbmd.. I think while this situation is somewhat of an ethical conundrum, you can only really attest to the quality of your educational experiences. don't know if anyone has tried to talk to the resident in question to give the resident some feedback directly but it can be a useful starting point before sending the dogs after him.
Otherwise, If your group unanimously feels this way about this particular resident, and doesn't want to help his personal development by bringing it to his attention directly then it behooves you to let course leadership know, and give concrete examples of deficiencies, without judgement re: competency which you can't determine completely as subordinates/learners.
so you can say you were concerned about deficiencies in knowledgebase, inability to effectively communicate with you as a student, concerns with the role modeling as evidence by interactions with patients, etc... you can't say the guy seemed clueless and incompetent.
state medical boards want to know about incompetence and patient harm, but usually from the victims of that harm -- from the patients themselves.
clerkship leadership can take the issue up with residency leadership who can then choose to follow the issue further.
Thank you for your comments.
The school already has anonymous feedback in place. That, of course was going to be the first place all of us started. We dont want to make waves but we also dont want to sit by while a person slips by.
Perhaps our exposure to the different types of doctors is limited but none of us can understand how this person has gotten this far without being fired.
Let's for a moment assume that this person is not fit to be a doctor. Outside of our administration, is there anything else a responsible person should or could do?
An anonymous letter to the state medical board could ruin this resident's career. Honestly, your examples haven't convinced me that he's incompetent, and any grandiose yet anonymous action by you at this time would be completely inappropriate.
Of course, that's what everyone has said to you so far in this thread, and you've responded by doing it anyway, and then changing the question so we'll tell you what you want to hear.
The most you should do is talk to the program director. Anything beyond that is absolutely inappropriate. Don't sabotage somebody's career when you don't know what you're talking about.
You have limited exposure to this resident. You admit that you don't know his full back story, yet you base a large part of his "incompetence" on assumptions. You can give only 2-3 crappy examples of why he shouldn't be a doctor, none of which are convincing. And, more importantly than all this, you are not in a position as a third year med student to make these types of judgments.
We've all had bad residents. Suck it up.
Even experienced physicians can make a mistake with the local anesthesia. For that matter, even experienced physicians can and do make mistakes which will cause patients much more serious harm than a little pain. It does not necessarily mean they will be or should be stripped of their licenses. Don't forget, this guy is still a trainee, too.
We get it, you don't think this guy is a very good physician, and there is a good chance you are right. While med students don't know everything, it is often easy to tell whether a preceptor is a good doc or not. Does that mean you should contact licensing authorities? No. As others have said, the appropriate step is to voice your concerns to the attending in charge or an administrator at your school. From there you've lived up to your responsibility, and the ball is out of your court.
Let's say you were a mate on a fishing boat, and you witnessed your captain making poor navigation decisions and putting the boat at risk of running aground. Would the appropriate move be to let the owner of the company know, or to contact the Coast Guard directly to try to get his captain's license revoked? There is a hierarchy involved here. Give it a chance to work. If this guy is as bad as you say, I'm sure there will be more complaints, and an investigation will be launched.
You made an anonymous account hopefully to write about all the deficiencies of this individual but the only things you were able to come up with were his inability to anesthetize properly, a bad lecture he gave you (not everyone is cut out to give good lectures - particularly if they are nervous and haven't done many before), and a questionable release from a previous residency (for which you seemed initially convinced was true but have no proof of such). None of those warrant getting this resident reported to the state board.
Agree with above comments.
You have no basis for going to the state medical board, nor would it be appropriate. Furthermore, this guy probably does not have a medical license yet, as he is an FMG and generally they can't get one until completing a residency, unlike US grads. Also, you seem to have appointment yourself God despite having <1 year on the ward on which to base your judgments about who is going to be a good physician vs. who is not.
I doubt the resident is anywhere near as "stupid and incompetent" as you seem to be convinced. For one thing, he has passed Step 1 and 2, and very likely Step 3 as well, in a language that is probably not his native language.
His giving you a crappy lecture and not seeming to remember all the details about MS don't really prove anything. If his neuro knowledge isn't good enough he won't be able to pass the neurology boards, and won't be able to call himself a neurologist. At any rate, I'm assuming you have <1 month's contact with this resident, which isn't nearly enough to assess his knowledge base. Also, you as a 3rd year medical student don't have the level of knowledge to assess that of a 3rd year neuro resident. Just because you remembered more about MS (or thought you did) doesn't really prove anything...the further one gets from 1st/2nd year, the less one tends to remember about basic science (unless one goes into lab research), but the more one learns about how to apply it.
Not being good at LP's at this point in his training could mean several things. The first one that comes to my mind is that this is a crappy neurology residency and nobody is teaching this guy. The fact that hey "fired a bunch of people" a couple of years ago is a big red flag. Which is more likely, that they just happened to recruit a bunch of stupid, malignant residents or that the program is malignant and/or has bad teaching. I can tell you which one I think is more likely. Not that it's not concerning, but I think you are rushing to judge. Also, some LP's are a lot more difficult than others, depending on the particular patient's anatomy and whether he/she is obese, has arthritis or prior surgery, etc.
It is totally appropriate for you to mention your concerns to your attending and/or your clerkship director in an appropriate way. Mentioning that you were concerned about the techniques on the LP, etc. would be O.K. Making blatant statements about "stupidity and incompetence" would be unhelpful and unwarranted.
The system has a way of "weeding out" folks who harm patients. It's called malpractice and the license of the attending (under whom this person is training) is subject to liability for the actions of the resident. Believe me, we take the supervision and training of residents pretty seriously.
Again, your school seems to have a great system in place for you to address your educational concerns. Take advantage of exercising this option but be very careful when you start attempting to critique the professional practice of a physician who is (FMG or no) more experienced than yourselves. I truly understand where you are coming from but other than addressing your concerns, at this point, you can't do much to get this person "fired" if he/she has the support of the attending medical staff (who actually assume the liability for this person anyway).
The best that you can hope for is that the attending staff will look more closely at the clinical performance of this person.
The most infuriating thing about this thread is the "concerned student's" self-righteousness in describing her concern for the patient's safety....
You already filed an anonymous complaint. Your only remaining option is to talk to your clerkship director really. Anything beyond that is stupid and might get you smacked down nicely.
Suck it up and move on.
every rotation and health care provider can teach you something, no matter how small. use this experience as "this a type of doctor I don't want to be" lesson.....and move on
I started this thread because I wanted advice before I did anything drastic. I am glad that I started it.
I do not appreciate the condescending remarks. Were some of you in my shoes I am confident you would feel the exact same way.
1. If you are confident you would not have deleted your posts.
2. Look at the people who responded to your posts. These are not the trolls. These are people who are holding their breath and trying to gently tell you not to do something monumentaly stupid.
3. If you are right, kudos. If you are wrong, God help you. I don't think that there is any conceivable way that you could know the difference.
4. A little food for thought, anything that it takes three people (even medical students) to decide to do is generally not a good idea. I promise you they don't let you hold hands in the disciplinary committee hearings.
Oh, absolutely. Patients may benefit from a lot of things that they don't get because they're at a teaching hospital.
What makes me mad is not concern for the patient. It's the patting-yourself-on-the-back "Yay! We're doing it for the patients! We're awesome" vibe I was getting. Some people feel so empowered by their righteous cause that they do stupid things, under the mask of selflessness.
One example is the mother who will cut to the front of the line at Walmart or demand immediate attention from an overwhelmed employee because "my child is sick (and I'd do anything for my child!)"
Or...you know....the Crusades.
I agree. I think "ConcernedStudent" is not so much concerned but self righteous and naive. 3rd year rotations are like any work environment; you have to get along with people that you normally wouldn't; people will screw up and you're no exception. Also, the idea that a 3rd year student is malicious and delusional enough to take her own preconceived notions of who "deserves" to be a doctor and judge a FMG, is really outrageous. I hope there is no one like that at my school.