Kicking out from residency program

[MDpride]

Hii

I recently read on SDN about someone either kicked out from residency program or made to resign residency program due to either poor performance or no improvement in performance.

What counts as poor performance in residency?

What is expected from a resident?

I'm third year medical student curious to know.

what can a medical student do during 3rd and 4th year so as to avoid being kicked out from residency program?

Thank You

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[ACSurgeon]

Hii

I recently read on SDN about someone either kicked out from residency program or made to resign residency program due to either poor performance or no improvement in performance.

What counts as poor performance in residency?

What is expected from a resident?

I'm third year medical student curious to know.

what can a medical student do during 3rd and 4th year so as to avoid being kicked out from residency program?

Thank You

This is a very general question to which there are a lot of "it depends." Depends on the specialty, the program, etc. The bottom line is that you have a knowledge base/skill set that you have to become competent in during residency. I don't personally know of any residents who were fired, but from what I've heard is that things that can get you fired include:

1- Clear shortcomings: not showing up on time, not responding to pages in a timely manner, 'failing' in service exams, being negligent towards your patients, etc.

2- Having a major personality disorder: aka not getting along with anyone to the point of crippling the team dynamics. You have to be a major douche for this to happen.

3- Bad luck (rarely): this is like "idiopathic" on any differential diagnosis you make. If you rub someone important enough the wrong way, they might find a way to get rid of you.

Overall, any medical student graduating from an American medical school has what it takes to go through a residency training program. Some switch training programs for location or specialty change purposes, but overall, most residents finish their training program. Just remember that if a program fires a resident, then the program becomes short a resident, and that's a lose-lose situation.

What you can do: try to learn as much as possible from each rotation. Try to refine that skill that is finding time to read despite being on a busy rotation. Develop good work ethic ie take your job seriously.

 

[penguin24]

This is a pretty rare situation for somebody to get truly 'fired' from residency. From what I understand, this was more common in the past (i.e. a 4th year surgery resident would suddenly get fired) I think the worst-case scenario these days is for the resident to repeat the year.

However, it's not impossible to imagine a resident getting fired. As we all know, the patient comes first, they are more impt than the number of years we spent in school, the amt of money we are in debt, ect. If a resident does not have what it takes to practice the specialty and they are a danger to their patients due to their lack of skills, then the residency program has a moral obligation to fire them.

 

[Smurfette]

Keep in mind that there are also situations where a contract is not renewed (more or less getting fired) as opposed to truly fired mid-year with little to no notice.

Usually people who have poor/weak clinical abilities are not renewed (or the person resigns mid-year), but it usually takes something pretty egregious to be fired mid-year. Only person I've known personally to be fired in residency was fired due to theft and had been defrauding the hospital.

 

[DrBowtie]

Keep in mind that there are also situations where a contract is not renewed (more or less getting fired) as opposed to truly fired mid-year with little to no notice.

Usually people who have poor/weak clinical abilities are not renewed (or the person resigns mid-year), but it usually takes something pretty egregious to be fired mid-year. Only person I've known personally to be fired in residency was fired due to theft and had been defrauding the hospital.

Yep seems like major professionalism issues (lying, stealing, cheating, showing up late, ignoring pages, yelling at ancillary staff) will lead to the swift boot.

Poor clinical evals usually leads to at least some chance at remediation during the year and their contract will just not be renewed.

(No personal experience just from what I've heard from my attendings/residents)

 

[MDpride]

Keep in mind that there are also situations where a contract is not renewed (more or less getting fired) as opposed to truly fired mid-year with little to no notice.

Usually people who have poor/weak clinical abilities are not renewed (or the person resigns mid-year), but it usually takes something pretty egregious to be fired mid-year. Only person I've known personally to be fired in residency was fired due to theft and had been defrauding the hospital.

can u please give example of a clinical skill mistake/lack not acceptable at resident level?

Thnx

 

[Danlee07]

is it like working in a lab where if you keep coming in late/not showing up or keep breaking/making the same mistake over? i know of 1 undergrad who was on work study that got fired because of this...

 

[sylph]

One of the posters above mentioned rubbing important people the wrong way--that is definitely a threat people should know about. My husband has told me numerous times about the messed up things that went on in his residency program. The program directors would pass off all of their work on the residents, who would in turn pass off their work to the newest residents and just take vacation days, etc. Anyone who tried to report the corruption ran into trouble from the attendings, and they even tried to get rid of one guy. This was supposedly a highly ranked / prestigious program, too. There is definitely a lot of screwed up politics involved in medicine. As much as nobody likes kissing a**, sometimes it's just something you have to learn to do to stay under the radar.

 

[Smurfette]

It's highly variable depending on what specialty, level of training and program you are at. A surgery intern and an IM intern have different expectations and experiences that aren't necessarily comparable, especially over time.

You are taking it too literally. Everything is relative. As an intern, people know you don't know things and expect you to ask questions and need help for certain (most) things. I don't expect an early surgery intern to know my standard postop stuff for a lap chole. But if you are a PGY5 surgery resident and don't know how to manage a straight-forward lap chole patient, that is a HUGE problem. And you wouldn't be promoted to be a PGY5 in that case...you'd be long gone from the program.

In residency, things are more about being compared to others at your level of training. And that is usually a sizable range. It is not about the mistakes themselves (everyone makes mistakes, it just varies as to what type of mistakes), but your level of understanding and ability to learn that is of concern. If your clinical ability as a senior resident is below that of your students or interns, that's a problem. If you make a typical mistake that others at your level commonly make, then learn from it and move on.

Generally speaking, you don't get kicked out for one thing. Exception would be for something egregious (like intentionally harming someone or doing something illegal). For the most part, you get multiple chances. But if you have done the same thing 10 times after being told after each of the first 9 times what you should and should not have done for that situation, you're in trouble. If you ignore what your superiors tell you to do on a regular basis, you're not going to last long. If you have major personality issues and clash with everyone you work with, you're not going to last long. If you don't learn from your mistakes, you're not going to make it. Basically, all these things make you unreliable and untrustworthy to your peers, seniors and attendings as well as a danger to patients.

As a med student, you make mistakes and learn. You don't get kicked out for making the typical mistakes that students make, or even some of the more uncommon mistakes they make. That doesn't go away when you become a resident; you make mistakes.

 

[majik1213]

This is a very general question to which there are a lot of "it depends." Depends on the specialty, the program, etc. The bottom line is that you have a knowledge base/skill set that you have to become competent in during residency. I don't personally know of any residents who were fired, but from what I've heard is that things that can get you fired include:

1- Clear shortcomings: not showing up on time, not responding to pages in a timely manner, 'failing' in service exams, being negligent towards your patients, etc.

2- Having a major personality disorder: aka not getting along with anyone to the point of crippling the team dynamics. You have to be a major douche for this to happen.

3- Bad luck (rarely): this is like "idiopathic" on any differential diagnosis you make. If you rub someone important enough the wrong way, they might find a way to get rid of you.

Overall, any medical student graduating from an American medical school has what it takes to go through a residency training program. Some switch training programs for location or specialty change purposes, but overall, most residents finish their training program. Just remember that if a program fires a resident, then the program becomes short a resident, and that's a lose-lose situation.

What you can do: try to learn as much as possible from each rotation. Try to refine that skill that is finding time to read despite being on a busy rotation. Develop good work ethic ie take your job seriously.

Lazymed, that description is excellent and comprehensive. For number 3, I just want to add that the rarity may be due to under-detection rather than a truly low prevalence. In either case, as you pointed out, it is rare.

 

[LossForWords]

I knew of a fella at my institution that was an IM resident. He was putting in a Swan when he lost hold of the guidewire and the whole thing slipped in. Rather than tell anyone, which would have earned him a huge ass chewing but not a dismissal, he just didn't say anything. They found it on x-ray later that day. THEN he was kicked out.

 

[deuist]

There is a major difference between getting fired mid-year versus not getting a contract renewed. I went to surgical program that was known for not renewing contracts if clinical performance and in-service exams were poor. There were two firings during the time I was there, however. One was for a resident who was selling opioid prescriptions on the side. The other was a new resident who supposedly lied about taking Step 3. Unprofessionalism will get you kicked out quicker than incompetence.

 

[Bluesaurus]

(i.e. a 4th year surgery resident would suddenly get fired)

That makes me sick thinking about it. The first three years of surgery are the scut work...well not scut but like the hustle work.

Then the 4 and 5's do the "fun stuff." To use a resident for three years of 100 hour weeks and then throw them overboard after they are no longer useful to manage the "hustle work" would make someone go crazy.