At my residency program they have non-medical employees such as nurses and social workers evaluate the residents. I can't imagine this is typical but wanted to hear from other residents or attendings about this.
Is this typical in residency?
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this is fairly common actually. I am assuming you are talking about 360 evals where other staff evaluate you on aspects such as professionalism, communication skills, working with others. They should not be evaluating you clinical skills, medical knowledge etc. depending on how its done (like if you have to ask 10 other people to evaluate you it can be potentially useful in how you are perceived by others). at my program you just ask one person quarterly to do this so it's a waste of time as you obviously ask someone who likes you and is going to say nice things about you!
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Agreed. This goes against how 360 eval's are supposed to work. Ideally, they should be given to as many people as possible from as many different fields as possible that are familiar with you at one point in time. Anything else and it really ceases to be a good tool.
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Also have 360 evals at my program. Agree that the practice of choosing someone to evaluate you iquartery as described above is ill-conceived and pointless. Where I am, you don't have a choice in the matter and on virtually every rotation there's at least one non-MD providing an eval.
So let me make sure I have this straight. There is a shortage of psychiatrists resulting in some states giving psychologists prescription rights and extending more rights to PAs and NPs, and the field of psychiatry imposes one more way for residents to fail and be fired? And it is even more ridiculous than that; evaluations from nurses and social workers say nothing about how competent and skilled a psychiatry resident is. All it shows is how "nice" the resident is to other employees. I understand that medicine as a field is becoming less desirable for the best and brightest, but this is completely absurd and shows another way in which doctors are losing autonomy and prestige.
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You are likely already getting lots of evaluation by other psychiatrists about your clinical skills. The idea behind 360 evaluations is that you are evaluated on how well you work with others on the team.
This isn't something medicine came up with. It's been used in the business community for quite a while. One of the reasons it came about was that executives were rated by senior executives, which really skewed evaluations to how well someone could toady. You manage up and you manage down and without something like a 360, it's hard to evaluate how you manage down. 360 evals are particularly useful for individuals in fields where you have a disproportionate amount of ***** kissing up the hierarchy and holier-than-thou attitudes towards people not seen as "peers." So you can see why it's a natural fit for medicine.
When someone gets great evaluations from faculty and lousy ones from nurses and social workers, it's likely a sign he needs to work on his interpersonal skills. 360 evals aren't going to lead to someone getting fired more than anything else at the hospital. They're just another evaluation tool. I wouldn't sweat them anymore than I would sweat any other kind of evaluation. And if you're sweating evaluations, that's instructive. And kind of the point.
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You may be surprised to learn that this actually matters. Working well on an interdisciplinary team is an important skill that actually affects patient care (at least I expect that it does for a variety of reasons).
If you can't get good evals from non-psychiatrist then you actually have a problem that should be addressed. Did you get a bad eval, or are you just afraid of that happening?
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Staff members should give their input,
Some attendings and residents don't answer their beepers, respond to requests that need to be timely such as emergency meds or codes, or work with a social work on the proper disposition. A staff member complaining about that has every right to do so and this is an area attendings often miss because it's not their butts on the line.
Where I am now, the staff members in general are excellent. I'd want them rating residents. If a staff member in particular is bad, my stock in their evaluation will go down. If they are good, it'll go up. The four social workers on my unit are all excellent. They tell me something, it has a high stock value.
That said, where I did residency, I wouldn't trust several of the staff members I've seen there. Some of them were willing to blatantly lie about a clinical situation to mislead the attending to do what was easier for the staff members and not right for the patient. Some of those nurses would give a bad eval to residents trying to do the right thing.
IMHO staff members should give their input but should not be able to give a written eval that goes into the residents' permanent record. If I were an attending where I did residency, if a bad staff member gave a review of a resident, it'd have very little effect on me. A good staff member, that'd be the opposite.
Not if that nurse or social worker rocks. Some of them do.
Some attendings and residents don't answer their beepers, respond to requests that need to be timely such as emergency meds or codes, or work with a social work on the proper disposition. A staff member complaining about that has every right to do so and this is an area attendings often miss because it's not their butts on the line.
Where I am now, the staff members in general are excellent. I'd want them rating residents. If a staff member in particular is bad, my stock in their evaluation will go down. If they are good, it'll go up. The four social workers on my unit are all excellent. They tell me something, it has a high stock value.
That said, where I did residency, I wouldn't trust several of the staff members I've seen there. Some of them were willing to blatantly lie about a clinical situation to mislead the attending to do what was easier for the staff members and not right for the patient. Some of those nurses would give a bad eval to residents trying to do the right thing.
IMHO staff members should give their input but should not be able to give a written eval that goes into the residents' permanent record. If I were an attending where I did residency, if a bad staff member gave a review of a resident, it'd have very little effect on me. A good staff member, that'd be the opposite.
No I did not receive a bad evaluation from a nurse; I get along well with nurses. That is not the point. I do not like that the medical profession is allowing so many people to trample it. We are going to sit back and watch as more of the nation's few truly gifted people choose business or other careers over medicine. Truly intelligent people desire autonomy and reward in the form of good pay; as these evaporate in the medical field (largely by our own doing, but not entirely) fewer intelligent people are going to choose it. Again I will say that it is ridiculous that nurses have any say about a physician's career unless that physician is doing something egregious. The problem of medicine not attracting the brightest people worries me not just as a doctor, but as a future patient and the son and friend of patients.
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Getting along with office and hospital staff is an integral part of being a good doctor. Hospitals and offices don't run as well without relationships of mutual respect between these parties. Being well-liked by nurses and social workers is not a popularity contest. It is meaningful. It shows you work well with others, the staff feels good, and patients end up getting better care because of this teamwork. I worked in the office of a psychologist once who was borderline abusive of his receptionist. She, in turn, would shirk certain responsibilities in a passive aggressive attempt to get back at him. The entire office (efficiency, patient care, general morale) suffered.
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Then this is a problem that needs to be dealt with in the administrative and educations wings of the department.
These things do happen. Happened to me. It's a sign of a malignant program and they're out there. My first rotation in residency, the attending blew and didn't teach, and the nurses too were bad. Double whammy. As I became a 2nd year, I started to realize the attending really was bad. He was a graduate of the program and the nurses told me he was one of the worst residents ever and didn't get any better as an attending (the good nurses that is). My last year, the new PD that came in was in residency while he was and she also mentioned that guy wasn't good.
Overall my residency experience was good, but that (among others) was definitely a problem in that program. While this is off on a tangent, while my overall experience was good, I saw a lot of signs showing the program was getting significantly worse in my last year. I was happy to leave when I did.
Only thing I can tell medical students is avoid malignant programs. If you're a resident already trapped in one, well can't do much there. It's difficult if not next to impossible to transfer out of a program. Complaining in a malignant program is difficult because such programs often times take it personally instead of a sign they need to improve and may try to make life hell for the resident.
These things do happen. Happened to me. It's a sign of a malignant program and they're out there. My first rotation in residency, the attending blew and didn't teach, and the nurses too were bad. Double whammy. As I became a 2nd year, I started to realize the attending really was bad. He was a graduate of the program and the nurses told me he was one of the worst residents ever and didn't get any better as an attending (the good nurses that is). My last year, the new PD that came in was in residency while he was and she also mentioned that guy wasn't good.
Overall my residency experience was good, but that (among others) was definitely a problem in that program. While this is off on a tangent, while my overall experience was good, I saw a lot of signs showing the program was getting significantly worse in my last year. I was happy to leave when I did.
Only thing I can tell medical students is avoid malignant programs. If you're a resident already trapped in one, well can't do much there. It's difficult if not next to impossible to transfer out of a program. Complaining in a malignant program is difficult because such programs often times take it personally instead of a sign they need to improve and may try to make life hell for the resident.
What made the attending bad?
Why is it so difficult to get out of a malignant program?
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That's not at all what's happening, and it's odd to me that this is how you view it.
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Didn't teach, cut-corners, his main objective was to get out of work as early as possible.
He wanted residents just to make his day go easier.
He was a nice guy, just was lazy.
You can leave anytime you want. Getting into another program and retaining your credit/work is another. Most programs only have an open spot if they lose a resident, and that rarely happens.
Explain what you mean.
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The medical profession isn't being trampled by having people with other degrees give residents evaluations. There's just no trampling. It's nonsensical.
That's not the only way the medical field is getting trampled but it's one of the ways. Lower pay, lower prestige, and less autonomy are the main things that concern me, not just for my career but for attracting bright and competent people to be doctors.
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Or the field will attract bright and competent people less focused on money, prestige, and power. For every two people accepted to medical school, there's another equally qualified applicant waiting to take their place. I'm not particularly sweating the field shaking off a few folks that are worried about their salary (which is still top 4% in this country), their prestige (a silly thing to worry about, imho, but any prestige loss is the field's own undoing anyway), or their autonomy (doctor's still have way more than most fields, and doctor's paranoid about any management are scary).
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It's not hard to get out of a malignant program - often what happens is there is a mass evacuation to C/A after the 2nd year and the new host program becomes home for completing the remainder of the 3 years.
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360s are not very new and they are not unique to psychiatry. I believe they are in the common program requirements so they include surgery and medicine residents. It would be inappropriate to as an LCSW or maybe even a nurse about medical knowledge, but not so far off to ask about professionalism, communication, and system based learning. Most 360s tend to be bland, but they can be useful in confirming problems that are suspected.
“I’m not the problem, that is just nurse so and so…”
“Really, it looks like it is also so and so, so and so, and so forth.”
There is a tension between anonymity and the right to face one’s accusers, but consistent themes do emerge when there is a consistent problem. Training can be a real pressure cooker and it sometimes brings out the worst in people. Getting feedback about how you show signs of stress is a good thing to learn during training, and a bad thing to learn after you are out there. While 360s could potentially be misused, the intent is very legitimate and they are better to have than to ignore the problems they can point out.
“I’m not the problem, that is just nurse so and so…”
“Really, it looks like it is also so and so, so and so, and so forth.”
There is a tension between anonymity and the right to face one’s accusers, but consistent themes do emerge when there is a consistent problem. Training can be a real pressure cooker and it sometimes brings out the worst in people. Getting feedback about how you show signs of stress is a good thing to learn during training, and a bad thing to learn after you are out there. While 360s could potentially be misused, the intent is very legitimate and they are better to have than to ignore the problems they can point out.
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You bring up an interesting yet potent dichotomy. If the training is stressful and anxiety provoking, how could one be truly be able to develop professionally? I'm not going to jump on any kind of bandwagon throwing programs onto the train tracks, but in general, most programs aren't that nuturing to identify actual positive personal traits due to the energy and time consumption. 360 evals aren't true evaluations of a persons best, only reactions as the environment dictates the tone.
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I wouldn’t disagree with you, but 360s are forced upon us. What form they take is up to the program. They few I have seen ask how good or bad trainees are at communication, professionalism,… They include positive and negative comment sections. How they are used is also up to the program. If psychiatry training isn’t nurturing, gosh help some of the other disciplines.
Often these things are a set up for grade inflation. When people evaluate each other, everyone is perfect. The problem with this is that when there is a problem, everyone has a file full of straight As. This presents quite a problem for the PD or the chairman to deal with problem residents or faculty.
Often these things are a set up for grade inflation. When people evaluate each other, everyone is perfect. The problem with this is that when there is a problem, everyone has a file full of straight As. This presents quite a problem for the PD or the chairman to deal with problem residents or faculty.
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I'd argue how could one develop professionally if the training isn't. I would prefer to have an environment in which I'm challenged and stressed and learn how to multi-task complex and unclear situations during residency, when I have built in back-up, mentoring, and moral support. You can still have this environment combined with a nurturing and positive residency environment.
I realize it's stylistic, but that's the great thing about the diversity of residency programs. There are different environments to cater to different personality types. Some folks have a higher tolerance for stress/anxiety and like to be challenged, whereas others are a little more adverse to this. There are fine programs that would be a good fit for either type of resident. The issue isn't so much with the residency programs' style, it's applicants being able to get a good feel for which residency program is which and (much more importantly) who they really are (as opposed to who they aspire to be) and how they'll best learn and grown.
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There in lies the rub. It's too subjective and left up to the fox to watch over chicken coop.
So, I question the validity. I don't believe this is the best way or some other aged dogma "that's always how it's been done". Or under the guise of ivory tower megalomaniacs. It is a broken system, it is flawed, and shouldn't be tolerated.
But we do. It's this apathy which drives us, and those who want to make changes are powerless.
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And I agree, from an enthusiastic yet naive point of view. I've only seen malignant training environments (both as a MS and MD) and truly doubt that medical education reform will occur, not when you continue to have questionable leadership.
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Yeah, that's the issue. We need to careful not to get tunnel vision. People who train in malignant environments can take on the "it's all going down hill, woe be the profession" and people who train in strong environments can take on the "everything's fine, quit whining."
But the truth is that medical education reform is occuring. It occurs regularly and constantly at stronger programs, as they realize that you can't tread water, you're either working to get better or allowing your program to get worse. The place medical education reform is not occurring is at malignant med schools and residency programs and it is an issue of choice. It's definitely not that there is not a push for medical education reform. It's out there and is happening.
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Local reforms are much more meaningful. Centralized universal change has been less than clearly helpful. Duty hours are a case in point. Are we better off with night floats, more hand offs, and shorter, but more frequent shifts? Good training involves a lot of work and experience, but it is also a matter of how it is handed out.
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Well said. However, I disagree that medical education or post-graduate education in a malignant institution is a choice. For example,~2007, training programs have filled to near capacity. This doesn't allow for a change in venue easily.
I have to also echo sentiments for doubts on centralized, universal changes. MacDonaldTriad spelled it out nicely.
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Yeah, I wouldn't even know what centralized, universal change looked like. But we have many great programs making significant changes to how they approach medical education and have been doing it for some time. Other programs have adopted similar changes. There is collaboration.
You have enough localized changes and you create a trend, which is what's been happening in med Ed reform. And there's no secret sauce or hidden solution. Programs who are not adapting are doing so by choice.
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This is an interesting discussion. My question to you is to what extent do you think that student/resident education reforms in our field is attributable to the fact that is to some relative extent a buyer's market? It seems like cruel forms of hierarchy are lessened in psychiatry or that these programs sink to the bottom faster.
But I'm not sure how I would pose that question of medical schools. It seems they're pretty well regulated into being responsive and somewhat benign. Are there malignant medical schools?
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There isn't much incentive for medical schools to be malignant. Sure, there are probably schools that work their 3rd years harder and have longer hours, but you're never really going to get work out of a clinical student, even if they are a rock star. There is no monetary incentive to enslave a med student, and 1st and 2nd years can only be pushed so hard before you start getting attrition and people taking lots of years off for "research" or "personal reasons", and that's going to cut into your tuition cash flow.
