PDs Asleep at the Switch?

[DarthNeurology]

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It seems like there are always threads in the General Residency Forum of SDN about "problem residents" or about residents being fired by residency programs and what is the next step for such a resident in terms of trying to get a new residency, should legal action be used, and what exactly the problem was.

While being labeled a "problem resident" is bad, one reference I found said that outside evaluators found that at many Internal Medicine programs perhaps 8 to 15% of residents had serious deficiencies. This lead me to wonder if PDs aren't somehow "Asleep at the Switch" and fix the problem simply by firing the resident. I found two references, pasted below which shows some supportive measures which could be prevent having problem residents. I was wondering if anybody feels that their program does or does not do these things for their residents and what impact this might have on resident education.

Supportive Factors that May Be Beneficial for Residents


• Early detection through timely evaluations• Prompt specific feedback and discussion of concerns• Orientation and communication of expectations at the beginning of every year• Advisor/advisee system• Faculty role models• Close resident camaraderie• Support groups among residents• Planned social events, retreats• Changing the schedule of highly stressed residents• Promotion of self-awareness and self-care
J Gen Intern Med. 2001 July; 16(7): 486–492.
doi: 10.1046/j.1525-1497.2001.016007486.x.


[FONT=verdana, arial, helvetica, sans-serif] National Survey of Internal Medicine Residency Program Directors Regarding Problem Residents .
[FONT=verdana, arial, helvetica, sans-serif] David C. Yao, MD, MPH; Scott M. Wright, MD .

[FONT=verdana, arial, helvetica, sans-serif] JAMA. 2000;284:1099-1104. .

[FONT=verdana, arial, helvetica, sans-serif][FONT=verdana, arial, helvetica, sans-serif]Preventive Measures..
[FONT=verdana, arial, helvetica, sans-serif]Program directors were asked to describe the measures in place that may benefit and support the well-being of their housestaff. More than 90% of the programs have the following: (1) orientation at the beginning of residency regarding expectations and supportive resources, (2) limited number of admissions on call days, (3) structured days off during ward rotations, (4) planned social events, and (5) parental leave policies. Seventy-three percent of programs have an advisory system, 48% sponsor retreats for interns and residents (ie, outings away from the hospital setting to assist in personal and professional development), and 35% offer intern/resident support groups or personal awareness groups. .
[FONT=verdana, arial, helvetica, sans-serif]Measures that program directors reported using to prevent deterioration and enhance the development of problem residents included regular meetings with program director and/or chief residents (94%), timely evaluations from attending physicians (87%), regular meetings of attending physicians with program director and/or department chairperson before and after ward rotations (49%), and switching rotations if the problem resident is particularly stressed and unable to perform at a high level (29%). .


I have seen a couple of residency programs that offer "retreats" with attendings and residents and other types of planned social events, and thought this was just a feel good thing, but maybe it indicates a residency program that is more willing to "go to bat" for its residents and less likely to fire a "problem resident" who maybe did not get timely and constructive feedback.

Anybody have any thoughts?

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[SocialistMD]

This lead me to wonder if PDs aren't somehow "Asleep at the Switch" and fix the problem simply by firing the resident. I found two references, pasted below which shows some supportive measures which could be prevent having problem residents. I was wondering if anybody feels that their program does or does not do these things for their residents and what impact this might have on resident education.

I have seen a couple of residency programs that offer "retreats" with attendings and residents and other types of planned social events, and thought this was just a feel good thing, but maybe it indicates a residency program that is more willing to "go to bat" for its residents and less likely to fire a "problem resident" who maybe did not get timely and constructive feedback.

Anybody have any thoughts?

Most "retreats" are held to keep up resident morale and aren't really to help identify "problem residents" (you are extrapolating from the abstract something it isn't saying). Early and frequent evaluations/meetings seem to be the best way to identify and help residents having difficulties, and it looks like 87-94% of programs do this in some form or another.

There are people who just aren't cut out to be [insert specialty here], despite having finished medical school and matched into that residency. Early identification can help the resident to identify that s/he has a problem, help him/her address that problem and can allow the program and resident to cut ties before wasting too much of either's time.

 

[dragonfly99]

Not sure any of these things on the list will necessarily help "problem residents" ...it would depend how these strategies are carried out, and who is carrying out the plan. Also, what is the definition of "problem resident" in the article? Is it someone who is lazy, has knowledge deficits, is depressed or anxious, or just doesn't get along well enough with others?

IMHO it's all the personal relationships between house staff, attendings, and the trainees + PD that are really important in a training program...that, and having enough work without being ridiculously overworked or something. All the rest is just window dressing. As far as resident retreats, etc. most all the ones I've been on have just been a picnic outside or something, and one had a career talk about "how to become an academic physician" but the lecture was totally forgettable.

 

[doc4life95]

Most "retreats" are held to keep up resident morale and aren't really to help identify "problem residents" (you are extrapolating from the abstract something it isn't saying). Early and frequent evaluations/meetings seem to be the best way to identify and help residents having difficulties, and it looks like 87-94% of programs do this in some form or another.

There are people who just aren't cut out to be [insert specialty here], despite having finished medical school and matched into that residency. Early identification can help the resident to identify that s/he has a problem, help him/her address that problem and can allow the program and resident to cut ties before wasting too much of either's time.

Not for nothing, do you have any criteria by which these residents who "arent cut out to be.." should be judged by?

or.... is it simply arbitrary?

 

[dacrocytic]

[FONT=verdana, arial, helvetica, sans-serif]and switching rotations if the problem resident is particularly stressed and unable to perform at a high level (29%). .
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Has anyone had to switch? If so how did your colleagues react?