Potential dismissal, need insight

[cucumbersupreme]

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I am preparing for an upcoming meeting to determine my dismissal eligibility after having received three Y-grades at my school alongside professionalism reports, and I am hoping for some guidance on how to approach the meeting and whether I will likely be looking at dismissal or some form of planned/structured remediation from the committee.

For some background, the courses that I fell through on are largely those that did not involve direct clinical care, and where clinical care was involved I have genuinely well-written, thoughtful evaluations that support me being a great clinician, "knowing my stuff", and having good bedside manner. Academically I would say I'm doing "fine" otherwise, and have grossly passed all of my clerkships moving forward into fourth year.

The full list of offenses is as follows:

In MS1 year:

• Remediating our school's pre-clerkship "in-between" course due to activities I forgot to log in a tracker that brought my grade below the 90% threshold. This was my first "Y" grade.

In MS3 year:

• A professionalism lapse regarding missing a due date for an updated vaccination, which I received a warning letter for.
• Remediating a clerkship due to missing assignments and incomplete observed required activities on my rotation checklist, resulting in a Y that has since been remediated to a passing grade.
• A professionalism lapse alongside the aforementioned remediation due to the nature of remediation being required.
• Remediating our inter-clerkship course due to missing due dates on assignments of varying weight spread out over the entirety of the MS3 year, just below the passing threshold, which became my third Y. Remediation has been completed and submitted, awaiting conversion.

All courses/activities were remediated properly and I have passing grades in them all otherwise at this point. I don't have any clinical performance concerns, patient safety issues, dishonesty, or boundary violations in my file.

I have a prior planned leave (just 3 weeks off + winter break) that the school supported, ongoing work with an academic coach, and I'm in the process of adding external counseling and engaging with my school's academic support office.

Not looking for reassurance necessarily, just looking for accurate information from people who've actually navigated this or watched someone close to them go through it.

 

[NotAProgDirector]

It's going to be difficult to generalize other's experiences because policies are going to vary widely among schools. From your description, it's clear you're having the same problem repeatedly -- missing deadlines, failing to get things submitted or logged. One would have hoped that after the first incident, you would come up with a better plan to ensure these things get done.

Getting help is good and something you should do, but there is concern that your school is going to assess that this is too little, too late. In any hearing, the key things you want to stress are 1) you understand this is a serious problem and accept that you have failed to meet minimum standards, and 2) have a plan to improve. From what you've written here, I'm not convinced on either point.

 

[GoSpursGo]

I agree with NAPD... it appears you received essentially 4 warnings and are now going to a committee meeting after a 5th violation (3 remediations, 2 professionalism lapses). So you have previously been warned about your performance, both academically and professionally, and then subsequently repeated each problem.

I'm outlining all this not to kick you while you're down, but to show you that you have demonstrated a pattern that you have failed to correct. I am struggling with how you have framed this:

For some background, the courses that I fell through on are largely those that did not involve direct clinical care, and where clinical care was involved I have genuinely well-written, thoughtful evaluations that support me being a great clinician, "knowing my stuff", and having good bedside manner. Academically I would say I'm doing "fine" otherwise, and have grossly passed all of my clerkships moving forward into fourth year.

What I'm hearing is... you're saying you're doing "fine," except for the 5 times that you didn't do fine, but we shouldn't care about those 5 times because it's all stuff that you think doesn't matter.

Unfortunately, you don't get to decide what does and doesn't matter, and good clinicians get themselves in a lot of trouble for behaving unprofessionally or not taking these sorts of "menial" tasks seriously. You have already been warned previously, and so if I was on the committee I'd probably be wondering why they should believe you're going to actually take this seriously this time if they let you off with one more warning.

If you do get to continue, consider this your final warning, and ensure you never ever miss another due date for anything between now and the end of your time in medical school.

 

[cucumbersupreme]

@NotAProgDirector & @GoSpursGo --
Thank you for your replies… you are right that it is an issue that went uncorrected, and I think I have silently been downplaying the significance of ongoing mental health issues and negative life events. This included/extended into downplaying the extent of the violations past.

I am thankful that communication with the dean of students has resulted in him saying that "the odds of dismissal are almost zero" and it was more or less a protocol-based trigger to be brought before the committee, though I am taking this very seriously.

I do have a plan moving forward that I am looking forward to presenting to the committee, including increased frequency of counseling (the school has only been able to provide once a month counseling), reaching out to the academic support services at my school, and developing some sort of accountability plan with the committee if they are willing. I am hoping they see my strong clinical work as evidence of my dedication, and are understanding of my extenuating circumstances having been the underlying cause of the "dropping off" of tasks that--in my mental state--I considered "lesser" or menial, as you had mentioned.

I am trying to stay hopeful in light of what the dean said, but will continue to worry and be dedicated to proving some level of change--if not for my status as a student, just for my health in general.

 

[Mr.Smile12]

@NotAProgDirector & @GoSpursGo --
Thank you for your replies… you are right that it is an issue that went uncorrected, and I think I have silently been downplaying the significance of ongoing mental health issues and negative life events. This included/extended into downplaying the extent of the violations past.

I am thankful that communication with the dean of students has resulted in him saying that "the odds of dismissal are almost zero" and it was more or less a protocol-based trigger to be brought before the committee, though I am taking this very seriously.

I do have a plan moving forward that I am looking forward to presenting to the committee, including increased frequency of counseling (the school has only been able to provide once a month counseling), reaching out to the academic support services at my school, and developing some sort of accountability plan with the committee if they are willing. I am hoping they see my strong clinical work as evidence of my dedication, and are understanding of my extenuating circumstances having been the underlying cause of the "dropping off" of tasks that--in my mental state--I considered "lesser" or menial, as you had mentioned.

I am trying to stay hopeful in light of what the dean said, but will continue to worry and be dedicated to proving some level of change--if not for my status as a student, just for my health in general.

I don't know what your student handbook says. But "silently downplaying" isn't carrying water after 4 citations. You can get dismissed for professionalism violations even if you have stellar clinical evaluations. Nothing compensates for bad professionalism violations.

I hope you have talked with your student services advocate, provided one exists for you, about your plan. In fact, you better get it vetted through enough student dean eyes (if you can) or a lawyer (see below) before you present it. Seeing that you aren't able to be self-accountable, I'm not sure if presenting a plan this late will cut it (IMO).

Read your handbook very carefully. See if there are lawyers who are expert at higher education/medical education issues who can give you pro bono advice on the matter. In my opinion, if you argue your mental health and life issues need time to resolve, I wouldn't be surprised if you got a recommendation for a suspension until the issues are satisfactorily resolved (within a period of time, like 1 year). Again, I don't know what your handbook says or where your 4 citations puts you, so we'll see what the process says.

P.S. I think a plan will be imposed on you. In the real world, a performance improvement plan is the sign you will get fired. Hopefully that isn't your destiny (getting kicked out).

 

[Goro]

I am hoping they see my strong clinical work as evidence of my dedication,

Hope is not a strategy.

In fact, I get a little nervous and seeing that you have written this, because you keep coming back to this idea. It is almost like magic thinking.

I'd like to know if you fully understand what thin ice you are on right now?

 

[eyeeye_captain]

In my experience, repeated professional issues correlate strongly with clinical ones, so I wouldn’t hang my hat on that.

Utilize the help to the fullest. You’re already four strikes deep.