PGY 4, need suggestions

[eaeaeay]

I started as a Prelim PGY 1/2 at a top tier program, eventually got transferred as a categorical PGY 3 to this decent community program with good autonomy and operative experience, as I was at a an academic powerhouse, my clinical experience was not on par with my new community program and eventually my judgement and operative skills were questioned and I was made to repeat my 4th year which I m doing now. Even with the best of my efforts, the faculty is not convinced that I have what it takes to be a surgeon (I believe I do), it's more of a snowball effect. I have done really well on all my tests (including skill tests) and I am being told that I may not graduate.

I really want to be a surgeon and have worked all my life to get here, in case my program does not promote me as a chief can I switch to another program as a PGY 4 or start a fellowship in the interim (Surgical Critical care / Transplant) and find my way back as a PGY 4? Is there anything I can do to convince my program? working really hard to impress. Will Medicare/program will pay for my repeat 4th year?

Really appreciate suggestions from the SDN community. Thanks for reading this long post

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[doc05]

Difficult to answer without knowing more. Try to be honest with yourself.

 

[eaeaeay]

Difficult to answer without knowing more. Try to be honest with yourself.

Thank you for your comments, happy to discuss more...preferably as a PM

 

[SLUser11]

I started as a Prelim PGY 1/2 at a top tier program, eventually got transferred as a categorical PGY 3 to this decent community program with good autonomy and operative experience, as I was at a an academic powerhouse, my clinical experience was not on par with my new community program and eventually my judgement and operative skills were questioned and I was made to repeat my 4th year which I m doing now. Even with the best of my efforts, the faculty is not convinced that I have what it takes to be a surgeon (I believe I do), it's more of a snowball effect. I have done really well on all my tests (including skill tests) and I am being told that I may not graduate.

I really want to be a surgeon and have worked all my life to get here, in case my program does not promote me as a chief can I switch to another program as a PGY 4 or start a fellowship in the interim (Surgical Critical care / Transplant) and find my way back as a PGY 4? Is there anything I can do to convince my program? working really hard to impress. Will Medicare/program will pay for my repeat 4th year?

Really appreciate suggestions from the SDN community. Thanks for reading this long post

Without knowing more, I would make the educated guess that you would not get a third chance. You should do everything in your power to stay in the program that you are currently in, and work tirelessly to regain their trust and respect. If you are a PGY3 transfer, repeat PGY4 year for sub-par performance, then go out to do a critical care year or whatever, there is a 99.9% chance you won't find a new home to complete your PGY4 and 5 years.

The hardest part is accepting the fact that you're below average. You can't focus on how unfair the situation is, or how you can score well on tests, etc (here on SDN you're insinuating that this somehow discredits your program's opinion). Most likely, you are under-performing. Accept it, find out how to fix it, and go from there. Often, it's not entirely clinical, so make sure you are communicating well, following directions well, and that your paperwork (logging hours, evals, etc) is PRISTINE! Read compulsively, practice your technique compulsively, pay closer attention to your co-residents and attendings....

...and that will be your best chance of becoming a board-eligible surgeon. You claim you've given the "best of my efforts." Try to give more. Find a mentor who will help you.

In my experience at several institutions, the under-performing resident typically doesn't pull himself/herself up by the bootstraps and become an all-star. Instead, the resident continues to do poorly, and often demonstrates poor insight, blaming others, or perhaps uncontrollable circumstances, for the bad work. THAT'S when a program will give up on you.

 

[ThoracicGuy]

Without knowing more, I would make the educated guess that you would not get a third chance. You should do everything in your power to stay in the program that you are currently in, and work tirelessly to regain their trust and respect. If you are a PGY3 transfer, repeat PGY4 year for sub-par performance, then go out to do a critical care year or whatever, there is a 99.9% chance you won't find a new home to complete your PGY4 and 5 years.

The hardest part is accepting the fact that you're below average. You can't focus on how unfair the situation is, or how you can score well on tests, etc (here on SDN you're insinuating that this somehow discredits your program's opinion). Most likely, you are under-performing. Accept it, find out how to fix it, and go from there. Often, it's not entirely clinical, so make sure you are communicating well, following directions well, and that your paperwork (logging hours, evals, etc) is PRISTINE! Read compulsively, practice your technique compulsively, pay closer attention to your co-residents and attendings....

...and that will be your best chance of becoming a board-eligible surgeon. You claim you've given the "best of my efforts." Try to give more. Find a mentor who will help you.

In my experience at several institutions, the under-performing resident typically doesn't pull himself/herself up by the bootstraps and become an all-star. Instead, the resident continues to do poorly, and often demonstrates poor insight, blaming others, or perhaps uncontrollable circumstances, for the bad work. THAT'S when a program will give up on you.

 

[Golding]

I've seen people go through pretty much this exact scenario, and I've seen it go both ways. The hard part about giving you any advice is that there are a lot of variables involved, in particular just how reasonable your staff is when it comes to acknowledging any change in deficiencies that they perceive. I've seen residents that were told to leave that managed to turn things around and finish. I've also seen residents that were held back only for the purpose of providing support for eventual termination. The differences were in the level of support staff gave at crucial times. If you get the sense that your program isn't going to even bother with you, I might suggest keeping an eye out for open PGY4 positions. I agree with SLUser11 that the idea of leaving to do a critical care year or transplant year and looking for a PGY4 position afterwards is risky, and may leave you empty handed. However, being terminated from residency is essentially a 100% death blow to your chances of finishing surgery residency anywhere.

 

[Vandalia]

I really want to be a surgeon and have worked all my life to get here, in case my program does not promote me as a chief can I switch to another program as a PGY 4 or start a fellowship in the interim (Surgical Critical care / Transplant) and find my way back as a PGY 4? Is there anything I can do to convince my program? working really hard to impress. Will Medicare/program will pay for my repeat 4th year?

I can't tell you what you should do, but I can definitely give you some general advice as to what you should not do.

I don't know if you have ever seen any of the cop shows, where the police are knocking on someone's door and they say, "Open the door! We are not going to go away!" Well, the faculty are not magically going to forget about you or forget their concerns.

Years ago we had an EM resident and we were very concerned about her knowledge and skill with pediatric patients. Her response after being told was to try to avoid every pediatric patient possible. That was definitely not what we were hoping to see. The problem is that when most people are confronted with weaknesses, they can tend to go into their shells. That is a path toward disaster.

If they are concerned about your skill in anastomosis, do every case possible that involves one. If they are concerned about your approach to cases with a lot of unknowns, do as much trauma as you can. If they are concerned about your work in breast cases, well you should get the idea.

As I said, the faculty are certainly not going to forget about you. You can either fold or go down swinging. (And even if you manage to find another program, that is not a panacea. Your reputation will definitely follow you, and it is almost certain that if faculty in one place see a problem, faculty in the second place will as well.)

 

[thedrjojo]

Wait, I could have done Transplant without finishing residency? Damn, I did this all wrong

Transplant fellowship would be a living hell if you aren't a competent surgeon. I was one of the better technical Chiefs at my program (my arms are sore from patting my back) and I know I have a **** ton of work to do to be able to do this Transplant ****. **** man, I just look at them wrong and lose 500ml of blood.