Nodding off

[nimbus]

Very odd story. Raise your hand if you’ve nodded off during a peds rotation during residency.

https://doctorscrossing.com/wp-content/uploads/2022/07/Episode-089-Transcript.pdf

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[2buckchuck]

Both the interviewer and interviewee seem to miss how easy it is in anesthesia specifically to divert controlled substances, the potential frequency with which it happens and how nodding off is one of the big red flags. If you do this long enough you will know someone or hear of someone that dies from this - I have known two in less than a decade.

And it’s not like you’re working at a hotdog stand - you can’t just be falling asleep during a case (and a peds mac case…geez).

 

[The Duck Knows]

Both the interviewer and interviewee seem to miss how easy it is in anesthesia specifically to divert controlled substances, the potential frequency with which it happens and how nodding off is one of the big red flags. If you do this long enough you will know someone or hear of someone that dies from this - I have known two in less than a decade.

And it’s not like you’re working at a hotdog stand - you can’t just be falling asleep during a case (and a peds mac case…geez).

I agree with you that it’s serious and I don’t blame them for having him undergo a urine or blood test. But once those came back negative that should have been the end of it.

I also agree that falling asleep during a case is serious, but when you’re working the equivalent of 2.0 FTE they can’t act like they don’t have a perfectly reasonable excuse for him to be exhausted.

The cherry on top is firing him for a “personality disorder” when nothing else turned up suspicious. I wasn’t aware that personality disorders caused drowsiness.

 

[Blockit]

The hospital was right to investigate. However reading the story it leads me to wonder if there were other issues at play; interpersonal issues. Maybe people didn’t like the guy and the end goal was to get rid of him no matter what the reason. Hospitals do this kind of thing often, they decide on an outcome and then engage in whatever deceptive and dishonest behavior that they can to achieve the desired outcome. The psychos in HR often assist in this.

 

[T-burglar]

Yeah this is quite the effort by the health system to get rid of this guy. There were other things going on besides falling asleep.

 

[The Duck Knows]

Yeah this is quite the effort by the health system to get rid of this guy. There were other things going on besides falling asleep.

Great points. This sounds much more likely now that I give it more thought.

 

[aneftp]

Well I’ve met a few older anesthesiologists. I’m convinced the real reason they can’t do solo anesthesia

They claim their backs hurt and they can’t hold their bladder for more than 2 hours for reasons not to be solo

Is that these older anesthesiologist have sleep apnea. I’ve see them nod off during middle of the day. And most of the time it’s heavier set docs who are prime sleep apneas memes.

 

[ProRealDoc]

The hospital was right to investigate. However reading the story it leads me to wonder if there were other issues at play; interpersonal issues. Maybe people didn’t like the guy and the end goal was to get rid of him no matter what the reason. Hospitals do this kind of thing often, they decide on an outcome and then engage in whatever deceptive and dishonest behavior that they can to achieve the desired outcome. The psychos in HR often assist in this.

Muslim guy in a Northeast hospital department full of people who don't like Muslims.

 

[abolt18]

Very odd story. Raise your hand if you’ve nodded off during a peds rotation during residency.

https://doctorscrossing.com/wp-content/uploads/2022/07/Episode-089-Transcript.pdf

-Raises Hand-

Not often, but more than once in the past I have caught myself nodding off, or thinking I only blinked but realizing my blink likely lasted a minute or two. Dark room, not enough sleep, smooth-sailing easy case, all make for a perfect storm sometimes. I typically will be proactive about getting up and walking around before it gets to that point, but it has happened.

Can't imagine it happening to me on a peds MAC case. I'm on high alert there, catecholamines circulating.

 

[neutro]

Personality disorder masqueraded as discrimination.

The guy published 25 papers and did 2 years of gen surg internship and made it without issues. But all of a sudden has a personality disorder?

Dont buy it.

 

[Beeftenderloin]

This is stupid.

ACGME/Admin: Here, work this high stress job, 80hrs/week, often 28hr shifts
Resident: Falls asleep
Admin: They must be on drugs

 

[Beeftenderloin]

We either collectively accept that X number of preventable, fatigue related deaths WILL happen every year and keep looking the other way. Or we pull our heads out of our collective asses and put some REASONABLE work hour restrictions in place for residents AND attendings, just like the airlines.

Future versions of us will look back on this practice the same way we view lobotomies and bloodletting. Primitive, barbaric, and frankly dangerous.

 

[Ronin786]

Pretty obvious the hospital tried to push him out the door.

Also if you read between the lines "And the year went well. There were certainly some challenges because this was a brand-new field for me and I perhaps hadn't really thought of, or prepared myself as well as I could have, having just come from general surgery training."

Sounds like he had some trouble fitting in initially and the hospital set out to get him. Seen it happen too frequently.

Nobody is going to give this guy slack over not being as "smart" as the brand new med students who are filled with answers. He was always going to be looked at as the IMG who couldn't get into general surgery.


I've definitely caught myself nodding off as a resident and would go step out and wash my face in the sterile area. Also programs love to say "you can always ask for a break if you're feeling sleepy" but then you get labelled as the high-maintenance resident.

 

[Bryan O’Blivion]

I once fell asleep during a neck dissection. I was sitting up, aspirated some of my own drool, and coughed myself awake. One of the surgeons asked me if I was ok, otherwise no one cared.

 

[Dantrolene FC]

We either collectively accept that X number of preventable, fatigue related deaths WILL happen every year and keep looking the other way. Or we pull our heads out of our collective asses and put some REASONABLE work hour restrictions in place for residents AND attendings, just like the airlines.

Future versions of us will look back on this practice the same way we view lobotomies and bloodletting. Primitive, barbaric, and frankly dangerous.

I envy the airline industry. But in the airline industry 100% of the flights are elective. And old engines can be replaced easily.

I can’t cure a patients heart failure or diabetes before we remove their colon cancer.

Anesthesia is more like the military flight industry. We go into battle worth fatigued pilots getting shot at.

 

[ucladoc2b]

I’ve taken to the habit of having an energy drink right before I drive if called in from home for this reason.

 

[Coffee PRN]

I’ve taken to the habit of having an energy drink right before I drive if called in from home for this reason.

What about the drive back, when you will inevitably be more tired and facing a caffeine crash?

 

[ucladoc2b]

What about the drive back, when you will inevitably be more tired and facing a caffeine crash?

Same

 

[Monty Python]

I envy the airline industry. But in the airline industry 100% of the flights are elective. And old engines can be replaced easily.

I can’t cure a patients heart failure or diabetes before we remove their colon cancer.

Anesthesia is more like the military flight industry. We go into battle worth fatigued pilots getting shot at.

Former USN aircrew here. There’s a pretty good policy on this, see page 8-14 (pdf page 188).

https://www.cnatra.navy.mil/tw6/vt10/assets/docs/training/cnaf-3710.7.pdf

 

[pgg]

I envy the airline industry. But in the airline industry 100% of the flights are elective. And old engines can be replaced easily.

I can’t cure a patients heart failure or diabetes before we remove their colon cancer.

Anesthesia is more like the military flight industry. We go into battle worth fatigued pilots getting shot at.

In medicine, 90% (?) of surgeries are elective. We absolutely COULD have airline-like hour limits and still cover emergencies. We'd just delay and do fewer elective cases.

That is, obviously, not economically acceptable to the administrators who talk a big talk about "high reliability organizations" and emulating the airline industry.

 

[pgg]

I once fell asleep during a neck dissection. I was sitting up, aspirated some of my own drool, and coughed myself awake. One of the surgeons asked me if I was ok, otherwise no one cared.

When I was an early MS3 on a gen surg block, doing a week with the vascular surgeons, I was scrubbed into some kind of endless neck vascular transposition thing, and doing nothing, not even retracting. Nobody could even be bothered to pimp me on the innervation of the platysma muscle, I was that invisible. Must've fallen asleep standing up and not been completely invisible, because the attending barked at me [SOMEONE ELSE'S NAME] EITHER STAY IN THE GAME OR SCRUB OUT

So I scrubbed out and went home. No one ever said anything. To tell the truth I'm not sure if they never noticed I was gone, or if they never realized I wasn't the other guy.


I fell asleep during morning report on that same rotation during a case presentation and that same attending snarled PGG WHAT WOULD YOU LIKE TO ASK THIS PATIENT and I had no idea what was going on and in this bleary fog of semi-consciousness I blurted out "what did he come in for again?" as a way to stall for time and he looked at me these hate-filled beady eyes and I think he died inside a little because he knew I was sleeping but by some miracle that was actually the answer he wanted, and he said YES WE NEVER HEARD A CHIEF COMPLAINT and then redirected his rage at the poor intern who was presenting the case in such an unacceptable manner.


And those are my two happiest memories of general surgery with the Blue team at Walter Reed Army Medical Center in July 2000. **** you Brennan, you were a dick.

 

[MirrorTodd]

When I was an early MS3 on a gen surg block, doing a week with the vascular surgeons, I was scrubbed into some kind of endless neck vascular transposition thing, and doing nothing, not even retracting. Nobody could even be bothered to pimp me on the innervation of the platysma muscle, I was that invisible. Must've fallen asleep standing up and not been completely invisible, because the attending barked at me [SOMEONE ELSE'S NAME] EITHER STAY IN THE GAME OR SCRUB OUT

So I scrubbed out and went home. No one ever said anything. To tell the truth I'm not sure if they never noticed I was gone, or if they never realized I wasn't the other guy.


I fell asleep during morning report on that same rotation during a case presentation and that same attending snarled PGG WHAT WOULD YOU LIKE TO ASK THIS PATIENT and I had no idea what was going on and in this bleary fog of semi-consciousness I blurted out "what did he come in for again?" as a way to stall for time and he looked at me these hate-filled beady eyes and I think he died inside a little because he knew I was sleeping but by some miracle that was actually the answer he wanted, and he said YES WE NEVER HEARD A CHIEF COMPLAINT and then redirected his rage at the poor intern who was presenting the case in such an unacceptable manner.


And those are my two happiest memories of general surgery with the Blue team at Walter Reed Army Medical Center in July 2000. **** you Brennan, you were a dick.

That's pretty ****ing hilarious.

 

[Gator7]

These things are going to happen as we are pushed to cover longer hours, later elective cases, more frequent call, etc.

I remember in training coming in for my OB shift at 6:30am and relieving the OB attending while she was sound asleep with her head in her hands in the OR while a c section was being closed. She was ending a solo 24hr shift at a facility that did >7,000 deliveries/year. I don’t think she needed a drug test, she needed a break.

On the other hand I have also relieved a partner that was sound asleep mid day with his feet up on the anesthesia machine and the monitor alarming because the last 5 BPs were in the 60s. Now that’s not okay

 

[Lashler9054]

Pretty obvious the hospital tried to push him out the door.

Also if you read between the lines "And the year went well. There were certainly some challenges because this was a brand-new field for me and I perhaps hadn't really thought of, or prepared myself as well as I could have, having just come from general surgery training."

Sounds like he had some trouble fitting in initially and the hospital set out to get him. Seen it happen too frequently.

Nobody is going to give this guy slack over not being as "smart" as the brand new med students who are filled with answers. He was always going to be looked at as the IMG who couldn't get into general surgery.


I've definitely caught myself nodding off as a resident and would go step out and wash my face in the sterile area. Also programs love to say "you can always ask for a break if you're feeling sleepy" but then you get labelled as the high-maintenance resident.

Well, at the beginning of the interview, he says his issues started with one sleeping incident in OR. But by the end of the interview, he implies there were multiple. So it’s a real big problem if you keep passing out in the OR

 

[makemoney2024]

Both the interviewer and interviewee seem to miss how easy it is in anesthesia specifically to divert controlled substances, the potential frequency with which it happens and how nodding off is one of the big red flags. If you do this long enough you will know someone or hear of someone that dies from this - I have known two in less than a decade.

And it’s not like you’re working at a hotdog stand - you can’t just be falling asleep during a case (and a peds mac case…geez).

Except all his tests and repeat testing came back negative. So maybe he’s telling the truth and being put thru the ringer for no reason?

 

[makemoney2024]

Muslim guy in a Northeast hospital department full of people who don't like Muslims.

Exactly. Chasing after the “clout” of prestige. This is the whole entire problem right here.

 

[makemoney2024]

Well, at the beginning of the interview, he says his issues started with one sleeping incident in OR. But by the end of the interview, he implies there were multiple. So it’s a real big problem if you keep passing out in the OR

Oh I don’t know. The stress of being investigated for something you aren’t doing and being put under the microscope will lead to a lot of sleepless nights. And maybe nodding off at inappropriate times because of lack of proper rest at night and anxiety mixed w depression maybe?

 

[Ashers]

I fell asleep during a c-section as an M3. The OB yelled "Bladder Retractor! Retract the bladder!" My name on that rotation was "Bladder Retractor."

 

[chessknt]

In medicine, 90% (?) of surgeries are elective. We absolutely COULD have airline-like hour limits and still cover emergencies. We'd just delay and do fewer elective cases.

That is, obviously, not economically acceptable to the administrators who talk a big talk about "high reliability organizations" and emulating the airline industry.

This traces back to the core problem of the medical industry in this country with surgery being the only thing that generates adequate revenue to keep the hospital open. It will never change but a lot would if it did.

 

[ucsfgaspain]

One of the most valuable undergrad classes I ever took was Sleep and Dreams by Dr. Dement in the 90's. I really do believe that all physicians should really have a basic understanding of sleep. It would counter so many false beliefs we have on sleep, sleep drive, sleep hygiene, etc. We equate falling asleep on the job with laziness, lack of willpower, drug use, etc. This premise is often incorrect. If one understood the data on the morbidity and mortality of inadquate sleep and circadian disruption due to shift work, I think many of us would alter our lifestyle and career decisions sooner. It does give me some hope that this is changing though. If you need further evidence, take a look at the association between athletic performance and sleeping.

 

[Burned_Out]

Very odd story. Raise your hand if you’ve nodded off during a peds rotation during residency.

https://doctorscrossing.com/wp-content/uploads/2022/07/Episode-089-Transcript.pdf

I went to an anesthesia residency with a Romanian gal who always got herself into trouble. She wasn't stupid but her laziness wore out her welcome there. For instance, she was the ICU resident on call once and overslept a code blue. When she showed up a 1/2 hour late, she said "oh I see you have everything under control, I'll just go back to sleep."

Well, the residency program booted her but she hired a lawyer to dispute the dismissal. It also helped that she got the state's ASA affiliate to lobby the program to take her back. In the end, the residency program was under pressure not to generate unwanted publicity and they let her complete her residency.

The moral is that although this gal deserved to be dismissed, others do not and they should hire the best damn attorney they can to go after their residency program.

 

[Lashler9054]

Oh I don’t know. The stress of being investigated for something you aren’t doing and being put under the microscope will lead to a lot of sleepless nights. And maybe nodding off at inappropriate times because of lack of proper rest at night and anxiety mixed w depression maybe?

Naw, he said he received testimony of sleep expert. I think he had something like narcolepsy which is an unfortunate thing to have as an anesthesiologist. My question to you is would you want an anesthesiologist with this affliction to take care of you? I wouldn’t

 

[neutro]

I went to an anesthesia residency with a Romanian gal who always got herself into trouble. She wasn't stupid but her laziness wore out her welcome there. For instance, she was the ICU resident on call once and overslept a code blue. When she showed up a 1/2 hour late, she said "oh I see you have everything under control, I'll just go back to sleep."

Well, the residency program booted her but she hired a lawyer to dispute the dismissal. It also helped that she got the state's ASA affiliate to lobby the program to take her back. In the end, the residency program was under pressure not to generate unwanted publicity and they let her complete her residency.

The moral is that although this gal deserved to be dismissed, others do not and they should hire the best damn attorney they can to go after their residency program.

That’s all fine but what does being Romanian have anything to do with this?

 

[nimbus]

That’s all fine but what does being Romanian have anything to do with this?

Talks funny. Just like Bulgarians.

 

[ProwlerturnGas]

That’s all fine but what does being Romanian have anything to do with this?

Maybe she’s anemic and the job keeps her from her blood letting duties.

 

[Beeftenderloin]

I went to an anesthesia residency with a Romanian gal who always got herself into trouble. She wasn't stupid but her laziness wore out her welcome there. For instance, she was the ICU resident on call once and overslept a code blue. When she showed up a 1/2 hour late, she said "oh I see you have everything under control, I'll just go back to sleep."

Well, the residency program booted her but she hired a lawyer to dispute the dismissal. It also helped that she got the state's ASA affiliate to lobby the program to take her back. In the end, the residency program was under pressure not to generate unwanted publicity and they let her complete her residency.

The moral is that although this gal deserved to be dismissed, others do not and they should hire the best damn attorney they can to go after their residency program.

Had a similar resident at my program a few years ahead of me in training. Failed ITE’s left and right, terrible evals, VERY poor interpersonal skills. PD at the time literally refused to graduate her. She similarly lawyered up. Claimed it was the programs fault, it was the programs responsibility to train her up, she didn’t fail, the program did, etc. PD wouldn’t budge. Hospital admin stepped in, literally booted him as PD, replaced him with a yes man, who allowed her a 6month “probationary period”, after which she got rubber stamped and passed through.

 

[makemoney2024]

Naw, he said he received testimony of sleep expert. I think he had something like narcolepsy which is an unfortunate thing to have as an anesthesiologist. My question to you is would you want an anesthesiologist with this affliction to take care of you? I wouldn’t

I didn’t read all that. Whatever the case I was saying it’s not necessarily related to drugs. And how did he get this far in life with a diagnosis of narcolepsy? Two GS internships are no joke. How did he do all this research and two years of training without a diagnosis?

 

[anaesthetic]

I didn’t read all that. Whatever the case I was saying it’s not necessarily related to drugs. And how did he get this far in life with a diagnosis of narcolepsy? Two GS internships are no joke. How did he do all this research and two years of training without a diagnosis?

I suspect he did it all while nodding off intermittently for three decades. Maybe every time he was supposed to see a physician, he nodded off instead. Use your imagination. A lot of doctors don’t have doctors.

 

[Burned_Out]

That’s all fine but what does being Romanian have anything to do with this?

She was an IMG.

 

[Burned_Out]

Had a similar resident at my program a few years ahead of me in training. Failed ITE’s left and right, terrible evals, VERY poor interpersonal skills. PD at the time literally refused to graduate her. She similarly lawyered up. Claimed it was the programs fault, it was the programs responsibility to train her up, she didn’t fail, the program did, etc. PD wouldn’t budge. Hospital admin stepped in, literally booted him as PD, replaced him with a yes man, who allowed her a 6month “probationary period”, after which she got rubber stamped and passed through.

With a good enough lawyer, they can even get the residency to seal those records & not disclose the probationary period. Also can compel the residency to write a letter of recommendation for their 1st job or fellowship opportunity. After a few years in practice, none of this past history will matter anymore.

I've seen hospitals, medical boards go after physicians through peer review. You should always lawyer up and know your legal rights.

 

[MirrorTodd]

With a good enough lawyer, they can even get the residency to seal those records & not disclose the probationary period. Also can compel the residency to write a letter of recommendation for their 1st job or fellowship opportunity. After a few years in practice, none of this past history will matter anymore.

I've seen hospitals, medical boards go after physicians through peer review. You should always lawyer up and know your legal rights.

Same as talking to the cops...just don't. Lawyer up and let them do the talking.

 

[pgg]

Had a similar resident at my program a few years ahead of me in training. Failed ITE’s left and right, terrible evals, VERY poor interpersonal skills. PD at the time literally refused to graduate her. She similarly lawyered up. Claimed it was the programs fault, it was the programs responsibility to train her up, she didn’t fail, the program did, etc. PD wouldn’t budge. Hospital admin stepped in, literally booted him as PD, replaced him with a yes man, who allowed her a 6month “probationary period”, after which she got rubber stamped and passed through.

Doesn't matter how bad or dangerous a resident is - if the program doesn't do the right things, and DOCUMENT, all of the feedback given to the resident, written evaluations documenting specific deficiencies in specific core competencies[1], minutes from clinical competence committee meetings, the steps taken to remediate the resident, notification to the resident concerning specific next steps if performance doesn't improve in a specific time period, the period of probation and further steps to remediate during that time ... absent all of that, the resident really can't be dismissed if they choose to fight.

In the grand scheme of things, this is as it should be - residents aren't just cheap labor. They're a decade or so into difficult education and training with a string of evaluations saying they're doing OK, else they wouldn't be residents at all. They have rights. They've made a commitment to the program, and the program should make a commitment to actually educating and training the resident.

It seems a lot of programs lack this kind of commitment, and/or don't document things well.



[1] It is, of course, difficult to get most attendings to write evaluations at all, much less ones involving uncomfortable and negative feedback. I confess guilt in this area as well, when I was at a teaching hospital. It's hard. The root of the problem is that 99% of attending physicians have exactly ZERO training on how to be educators. There's this dumb but pervasive idea that technical competence and knowledge implies the ability to teach, evaluate, provide feedback, remediate, etc. Collectively, we suck at it. Just another facet of the general physician hubris that we're very smart and therefore good at everything from investing to flying planes ... to teaching.

 

[MirrorTodd]

Doesn't matter how bad or dangerous a resident is - if the program doesn't do the right things, and DOCUMENT, all of the feedback given to the resident, written evaluations documenting specific deficiencies in specific core competencies[1], minutes from clinical competence committee meetings, the steps taken to remediate the resident, notification to the resident concerning specific next steps if performance doesn't improve in a specific time period, the period of probation and further steps to remediate during that time ... absent all of that, the resident really can't be dismissed if they choose to fight.

In the grand scheme of things, this is as it should be - residents aren't just cheap labor. They're a decade or so into difficult education and training with a string of evaluations saying they're doing OK, else they wouldn't be residents at all. They have rights. They've made a commitment to the program, and the program should make a commitment to actually educating and training the resident.

It seems a lot of programs lack this kind of commitment, and/or don't document things well.



[1] It is, of course, difficult to get most attendings to write evaluations at all, much less ones involving uncomfortable and negative feedback. I confess guilt in this area as well, when I was at a teaching hospital. It's hard. The root of the problem is that 99% of attending physicians have exactly ZERO training on how to be educators. There's this dumb but pervasive idea that technical competence and knowledge implies the ability to teach, evaluate, provide feedback, remediate, etc. Collectively, we suck at it. Just another facet of the general physician hubris that we're very smart and therefore good at everything from investing to flying planes ... to teaching.

That is so freaking true. Not to mention the amount of "teaching" that is passed down by residents cause programs are all labor focused and not education focused.

 

[kidthor]

I've seen hospitals, medical boards go after physicians through peer review. You should always lawyer up and know your legal rights.

A friend of mine got threatened with sham peer review at a toxic place because he reported serious safety issues to the government. He lawyered up immediately and the threat soon went away. But it did cost him a good 5K in legal fees.

 

[Blockit]

A friend of mine got threatened with sham peer review at a toxic place because he reported serious safety issues to the government. He lawyered up immediately and the threat soon went away. But it did cost him a good 5K in legal fees.

This will be an extreme view, and I apologize, but the individuals in hospital administration who attempt to ruin physicians to cover up their own negligent or criminal behavior deserve bullets.

 

[MirrorTodd]

This will be an extreme view, and I apologize, but the individuals in hospital administration who attempt to ruin physicians to cover up their own negligent or criminal behavior deserve bullets.

Certainly a stern talking to lol

 

[kidthor]

This will be an extreme view, and I apologize, but the individuals in hospital administration who attempt to ruin physicians to cover up their own negligent or criminal behavior deserve bullets.

At least they should be tried criminally and have their medical license revoked. In my state whistleblower retaliation is a criminal (and civil) offense. I suspect no prosecutor would want to touch such a case though.

 

[abolt18]

Doesn't matter how bad or dangerous a resident is - if the program doesn't do the right things, and DOCUMENT, all of the feedback given to the resident, written evaluations documenting specific deficiencies in specific core competencies[1], minutes from clinical competence committee meetings, the steps taken to remediate the resident, notification to the resident concerning specific next steps if performance doesn't improve in a specific time period, the period of probation and further steps to remediate during that time ... absent all of that, the resident really can't be dismissed if they choose to fight.

In the grand scheme of things, this is as it should be - residents aren't just cheap labor. They're a decade or so into difficult education and training with a string of evaluations saying they're doing OK, else they wouldn't be residents at all. They have rights. They've made a commitment to the program, and the program should make a commitment to actually educating and training the resident.

It seems a lot of programs lack this kind of commitment, and/or don't document things well.



[1] It is, of course, difficult to get most attendings to write evaluations at all, much less ones involving uncomfortable and negative feedback. I confess guilt in this area as well, when I was at a teaching hospital. It's hard. The root of the problem is that 99% of attending physicians have exactly ZERO training on how to be educators. There's this dumb but pervasive idea that technical competence and knowledge implies the ability to teach, evaluate, provide feedback, remediate, etc. Collectively, we suck at it. Just another facet of the general physician hubris that we're very smart and therefore good at everything from investing to flying planes ... to teaching.

100%.

In training I overheard faculty members talk about how they would NEVER give a bad eval to a resident, because residents just retaliate and give them bad evals, which can affect promotion. That always rubbed me wrong.

When I became faculty, I went to great lengths to talk with residents at the end of the day and give them feedback, good AND bad. If I felt they were receptive (they nearly always were), then I left them a reasonable eval and left out my negative critiques.

Once, however, I had a resident push back all day because she wasn't "comfortable" doing these cases that were new to her, and after talking to her (throughout the whole day) she was still rather unreceptive, so I left a very honest, negative eval for her. It's hard to do but it has to happen! For their sake, and for the sake of all our patients.

Now I don't work with any trainees and it's much less stress/work.