No renew for PGY-2 training. Need your advice!

[chestnut2008]

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I am an IMG and training in a PGY-1 pediatric residency program in a university affiliated hospital. A few days ago I was noticed that the program will not renew my contract (Although I am working hard, the program said they are not satisfied of my communication). I want to try to find chance to join other PGY-2 pediatric programs, anywhere. I am stressed and would like to get help for how to go through this process?

Sincerely appreciate your kind help!!!

 

[blanche]

APPD (assn of pediatric program directors) has a page of random open positions (residencies, fellowships, etc) sometimes, 'gems' can be found.


http://www.appd.org/communications/positions.cfm

Good luck!

 

[chestnut2008]

Hi Blanche,

Appreciate your great information. Thanks!!

Chestnut2008

 

[393656]

You have podiatrist in your sig---did you mean pediatrician? I can see the communication issue.

Don't you think its dangerous if you cant speak english well enough that your own program can't work with you? How can you competently take care of patients if you cannot communicate with parents, kids and colleages?

Instead of looking for another program why dont you take some time to better your english and re-apply. Would show more to the programs you are fixing your deliquency rather than killing a patient in the future because of a miscommunication.

 

[oldbearprofessor]

You have podiatrist in your sig---did you mean pediatrician? I can see the communication issue.

Don't you think its dangerous if you cant speak english well enough that your own program can't work with you? How can you competently take care of patients if you cannot communicate with parents, kids and colleages?

Instead of looking for another program why dont you take some time to better your english and re-apply. Would show more to the programs you are fixing your deliquency rather than killing a patient in the future because of a miscommunication.

This is unnecessarily harsh for someone not in pediatrics to cross-over to our forum to post. Especially given the multiple grammar errors in your post.

Foreign trained physicians, some of whom have limitations in their English can and do care for our pediatric patients very well. The OP is advised to spend extensive time talking with both his PD and multiple faculty to learn what went wrong and then go on from there. I am doubtful that the only issue was poor English communication. If so, then the OP would want to find out if they can take some time off of the current program to improve their English before returning to the same program. If, as I suspect, there are multiple issues, these should be addressed rather than trying to jump into a new program or focusing only on language issues.

 

[J-Rad]

I agree with both points OBP made above. Just to expand: a "communication" issue may have very little or nothing to do with specific difficulties with the English language or grammar. Rather, it is about the quality of one's communication with patients, families, co-workers, and colleagues. This issue transcends accents and Queen's English. Many residents struggle with the quality of their communication whether they are foreign born or from the US. As OBP alluded to, there are many fine physicians who speak in heavily accented English, who ensure the quality of their communication, nonetheless. I'm sure it is emotionally difficult to cope with this non-renewal, but use this opportunity to grow and learn what your program felt inhibited your ability to be an effective communicator. If you are open and willing, this might be something remediable and will serve you better when you reach the next step in your career progression.

Question: are you leaving in good standing? I always interpret a non-renewal of a contract as leaving in good standing (vs. being fired from the residency after failed remediation), but I'm sure the nuances of that may exceed my ken. Obviously, leaving with the program not willing to state that you would be suitable for further training somewhere else would be a difficult hurdle to surmount. But, if you are leaving with them willing to say: "yes, this person is suitable for further training elsewhere" you are in a better position. But understand, further training in pediatrics may not be in the cards for you. As part of your meeting you and your PD should sit and talk about what fields he/she feels you are suitable for. Sometimes they might think family medicine might be more appropriate, but (from what I've gathered from some of the wiser posters on SDN here) more often it is a field like psychiatry, pathology, or PM&R-ones with their own clinical challenges, but challenges much different than you face in pediatrics or internal medicine.

Just a few thoughts. Good luck to you.

 

[393656]

I agree with both points OBP made above. Just to expand: a "communication" issue may have very little or nothing to do with specific difficulties with the English language or grammar. Rather, it is about the quality of one's communication with patients, families, co-workers, and colleagues. This issue transcends accents and Queen's English. Many residents struggle with the quality of their communication whether they are foreign born or from the US. As OBP alluded to, there are many fine physicians who speak in heavily accented English, who ensure the quality of their communication, nonetheless. I'm sure it is emotionally difficult to cope with this non-renewal, but use this opportunity to grow and learn what your program felt inhibited your ability to be an effective communicator. If you are open and willing, this might be something remediable and will serve you better when you reach the next step in your career progression.

Question: are you leaving in good standing? I always interpret a non-renewal of a contract as leaving in good standing (vs. being fired from the residency after failed remediation), but I'm sure the nuances of that may exceed my ken. Obviously, leaving with the program not willing to state that you would be suitable for further training somewhere else would be a difficult hurdle to surmount. But, if you are leaving with them willing to say: "yes, this person is suitable for further training elsewhere" you are in a better position. But understand, further training in pediatrics may not be in the cards for you. As part of your meeting you and your PD should sit and talk about what fields he/she feels you are suitable for. Sometimes they might think family medicine might be more appropriate, but (from what I've gathered from some of the wiser posters on SDN here) more often it is a field like psychiatry, pathology, or PM&R-ones with their own clinical challenges, but challenges much different than you face in pediatrics or internal medicine.

Just a few thoughts. Good luck to you.

Good advice, choose psychiatry when someone is getting dropped for not being able to communicate. There is some solid advice.

I also did not know this was "your" forum and not open to anyone. Spelling also does not take away from the content of a message so pointing that out is just skirting the issue.

 

[J-Rad]

Good advice, choose psychiatry when someone is getting dropped for not being able to communicate. There is some solid advice...

Fair enough. Let me restate: Often, when inidividuals do not progress in an IM or pediatrics residency, FM, Psych, Path, Preventive a/o Occupational medicine, and PM&R are explored as possible alternative career paths. Individual aspects of the individual story may affect which ones are more viable than the others. For example, if one is having difficulty with clinical medicine in IM or peds, then FM and occupational medicine are probably poor alternatives. If quality of communication is an issue, FM or psych are probably both bad choices as well. This is a very individual matter and it behooves to OP to have an open and honest discussion with his/her PD.

 

[J-Rad]

...just skirting the issue.

I would argue that your commentary was so perfunctory so as to not be particularly useful. I don't think OBP or I "skirted" anything.

 

[Socrates25]

This is unnecessarily harsh for someone not in pediatrics to cross-over to our forum to post. Especially given the multiple grammar errors in your post.

Foreign trained physicians, some of whom have limitations in their English can and do care for our pediatric patients very well. The OP is advised to spend extensive time talking with both his PD and multiple faculty to learn what went wrong and then go on from there. I am doubtful that the only issue was poor English communication. If so, then the OP would want to find out if they can take some time off of the current program to improve their English before returning to the same program. If, as I suspect, there are multiple issues, these should be addressed rather than trying to jump into a new program or focusing only on language issues.

Depends on what you mean by "limitations in English."

As a med student I rotated at an outside hospital that had a ton of FMGs. Most of them spoke very well, but one resident in particular was EXTREMELY difficult to understand.

We were on rounds and the attending (who is the program director) went inside the room. The FMG resident was giving the presentation. The patient, a 30 year old female, interrupted the FMG 4 times to tell her that she couldnt understand what she was saying. The attending rudely interrupted the patient and said this:

"It doesnt matter if you cant understand her, as long as I understand what she is saying that is all that matters."

I was shocked and appalled.

Moral of the story is that some people dont belong in medicine if they are so difficult to understand that an average patient cant communicate with them.

 

[Doctor4Life1769]

Pretty ballsy move by the PD...

What happened after that? Don't leave us hanging..... 👍

 

[michigangirl]

Depends on what you mean by "limitations in English."

As a med student I rotated at an outside hospital that had a ton of FMGs. Most of them spoke very well, but one resident in particular was EXTREMELY difficult to understand.

We were on rounds and the attending (who is the program director) went inside the room. The FMG resident was giving the presentation. The patient, a 30 year old female, interrupted the FMG 4 times to tell her that she couldnt understand what she was saying. The attending rudely interrupted the patient and said this:

"It doesnt matter if you cant understand her, as long as I understand what she is saying that is all that matters."

I was shocked and appalled.

Moral of the story is that some people dont belong in medicine if they are so difficult to understand that an average patient cant communicate with them.

This is a very close minded statement in the last line. Bedside presentations aren't meant to be understood by the patient. Apart from using medical language that most patients and families will not understand, rounds are really meant for the medical team. After the presentation the team can present the "big picture" in layman terms for the patient/family prn. You can't tell me you haven't met people who look some non-native english speakers straight in the face and tell them they don't understand them simply because they look different or have an accent. I can't name the number of times people didn't even attempt to understand my mother who speaks perfect english and has lived here for 30 years simply because she looked "ethnic" and had an accent. The patient in your story could have simply been commenting on the fact she didn't understand a presentation with so much medical language. The PD was actually correct-- probably didn't have to be so rude about it, but if he could understand the resident during ROUNDS and the resident was doing her job-- that's all that matters.

 

[Megalofyia]

This is a very close minded statement in the last line. Bedside presentations aren't meant to be understood by the patient. Apart from using medical language that most patients and families will not understand, rounds are really meant for the medical team. After the presentation the team can present the "big picture" in layman terms for the patient/family prn. You can't tell me you haven't met people who look some non-native english speakers straight in the face and tell them they don't understand them simply because they look different or have an accent. I can't name the number of times people didn't even attempt to understand my mother who speaks perfect english and has lived here for 30 years simply because she looked "ethnic" and had an accent. The patient in your story could have simply been commenting on the fact she didn't understand a presentation with so much medical language. The PD was actually correct-- probably didn't have to be so rude about it, but if he could understand the resident during ROUNDS and the resident was doing her job-- that's all that matters.

My mother has been asked if she was speaking English. She's Irish and English was her first language.

 

[blanche]

Sometimes 'communication' , like 'time management', can be a vague/ambiguous term that can be used as desciptor for deficiency in most anyone at some point in training. I've seen attdgs and clerkship directors target trainees this way, for right or wrong.. I wonder if someone had it out for the OP

 

[NOsquid]

Bad communication, poor time management, not a team player, unprofessional...

All code for "did not toe the line to our satisfaction"

 

[michigangirl]

It is EXTREMELY difficult to release someone from a training program. They can't just tell you they are not renewing your contract without some effort to work with you or remediate what they think you are having trouble with. Now, if they have been telling you for some time they were having issues with your communication and offered you opportunities for improvement, then that is one thing. If this is the first time you're hearing it, in May, then this is unacceptable. You can discuss this with the ACGME if that is the case. So I would make sure you have a long discussion with your program director and find out what your rights are from the ACGME standpoint.

 

[Giic]

Depends on what you mean by "limitations in English."

As a med student I rotated at an outside hospital that had a ton of FMGs. Most of them spoke very well, but one resident in particular was EXTREMELY difficult to understand.

We were on rounds and the attending (who is the program director) went inside the room. The FMG resident was giving the presentation. The patient, a 30 year old female, interrupted the FMG 4 times to tell her that she couldnt understand what she was saying. The attending rudely interrupted the patient and said this:

"It doesnt matter if you cant understand her, as long as I understand what she is saying that is all that matters."

I was shocked and appalled.

Moral of the story is that some people dont belong in medicine if they are so difficult to understand that an average patient cant communicate with them.

Huh? Some people don't belong in medicine? That's a big leap you took here.
I would actually support what the attending did in this story. If it was me, I would politely tell the patient that I need to listen to the presentation without interruptions, and that I would be sure to explain everything to her shortly after we were done. The main purpose of resident presentation is for the attending to understand and make a plan. That plan can then be communicated to the patient after the presentation is done.

And just because that one patient doesn't understand the resident does not mean this resident won't do a generally good job in future, and certainly does not mean that he/she "doesn't belong in medicine".... That's a ridiculous comment.

 

[one11]

Huh? Some people don't belong in medicine? That's a big leap you took here.
I would actually support what the attending did in this story. If it was me, I would politely tell the patient that I need to listen to the presentation without interruptions, and that I would be sure to explain everything to her shortly after we were done. The main purpose of resident presentation is for the attending to understand and make a plan. That plan can then be communicated to the patient after the presentation is done.

And just because that one patient doesn't understand the resident does not mean this resident won't do a generally good job in future, and certainly does not mean that he/she "doesn't belong in medicine".... That's a ridiculous comment.

Dude.. the resident that you are talking about is probably an attending now.

 

[Giic]

Dude.. the resident that you are talking about is probably an attending now.

Which resident? What are you talking about? Maybe you should read the thread carefully before you post...

 

[22031 Alum]

Which resident? What are you talking about? Maybe you should read the thread carefully before you post...

You resurrected a thread from 5 years ago.

 

[Giic]

You resurrected a thread from 5 years ago.

And?

 

[BigRedBeta]

And?

Common message board courtesy (everywhere, not just on SDN) discourages reviving threads that have long been dormant. The archives remain for search purposes, but otherwise reopening such threads does not provide relevant discussion. In this particular thread, the OP only came to SDN long enough to post 2 messages (both here and now almost 5 years old) and the poster that you are calling out hasn't posted in almost a year. It looks as though you are mainly trying to pick a fight.

 

[Giic]

Common message board courtesy (everywhere, not just on SDN) discourages reviving threads that have long been dormant. The archives remain for search purposes, but otherwise reopening such threads does not provide relevant discussion. In this particular thread, the OP only came to SDN long enough to post 2 messages (both here and now almost 5 years old) and the poster that you are calling out hasn't posted in almost a year. It looks as though you are mainly trying to pick a fight.

I disagree that "common message board courtesy" discourages reviving old threads. You will have to show me where that is printed. If I stumble across something that is rude and disparaging and offensive and xenophobic, I am going to comment - regardless of whether it was 5 years ago or 50 years ago. That person may have never heard an opposing view, and if they are an attending now, they could be offensive in the workplace. Also, to your point that the person I was replying has not been on SDN ever since -- well, medical students peruse these forums. They need to at least hear an opposing view and know what could be considered offensive. If indeed these threads are not meant to be made active, then the moderators can go ahead and archive them (like on Reddit and many other comment boards online).

No I am not picking a fight, and I find it surprising that my message is what bothers you (and not what I was complaining about).

 

[BigRedBeta]

I disagree that "common message board courtesy" discourages reviving old threads. You will have to show me where that is printed. If I stumble across something that is rude and disparaging and offensive and xenophobic, I am going to comment - regardless of whether it was 5 years ago or 50 years ago. That person may have never heard an opposing view, and if they are an attending now, they could be offensive in the workplace. Also, to your point that the person I was replying has not been on SDN ever since -- well, medical students peruse these forums. They need to at least hear an opposing view and know what could be considered offensive. If indeed these threads are not meant to be made active, then the moderators can go ahead and archive them (like on Reddit and many other comment boards online).

No I am not picking a fight, and I find it surprising that my message is what bothers you (and not what I was complaining about).

It's called necroposting, it's frowned upon. Unlike reddit where there is a function for the best content to stay at the top, you reviving old threads does not contribute in a meaningful way to current discussion (emphasis on CURRENT), the Peds forum is pretty slow, but in other more active areas of the forums, bringing up a dead thread is annoying and if done on larger scale, detrimental to people coming here looking for real help as their questions gets buried by long finished threads. Positive contributions to the discussion are encouraged in the SDN forum rules.
https://en.wikipedia.org/wiki/Internet_forum#Necroposting

If you find offensive content, rather than reraising the post so it can be seen by a broader audience, the SDN Terms Of Service require you to report said posts so the moderators can deal with them.

 

[oldbearprofessor]

A couple things. First, we do discourage unhelpful necroposting. In this case 5 years is more than 70 pages back which means no one could easily find it. There is no need to correct every perceived error on the internet from years ago for the sake of future generations. It would be better to bring up the topic as a new thread if you perceive it of importance. Therefore, I am going to close this thread and if someone wants to talk about the legitimate issue of whether family-centered rounds should be done such that the family is understanding the discussion at the time or other approaches to family rounds, start a new thread and we'll go from there.