So the bad news was delivered almost 3 weeks ago: probation for 4 months. ACGME notified, official letter, the whole nine yards. No time lost during residency, no effect on board eligibility (yet), and I will still be able to graduate on time if I fulfill the requirements. The issues involved are those of clinical knowledge and application (legitimate concerns), and professionalism (for coming across as defensive while receiving negative feedback, of all things.)
I was not given a remediation notice or period beforehand.
So I know this is going to follow me for the rest of my career. I can live with that, though it hurts a lot. What I'm wondering is how badly this will affect my chances of getting a decent job. I'm not looking to join the CDC or a major academic institution. And quite frankly, the field I'm going into is in need of warm bodies, so I've been told that will help.
I've begun working on my issues (PREP questions, heavier reading schedule, etc.), but I'd appreciate any input you all have on what else I can do.
Thanks!
First thing to do is to stop worrying about board eligibility and/or your chances of getting a decent job, and concentrate solely on successful completion of your remediation period and current residency.
Procedural issues
You say you didn't have a remediation notice or a remediation period. For your own peace of mind, you could check what your contract says about the procedures for dealing with performance issues, and cross-check that list with a list of what the program says happened and a list of what you think happened. That will show you where there have been any misunderstandings between you and the program, and whether there have been any things where the program has fallen down on its procedures.
If there have been any misunderstandings between you and the program, for instance about your performance or the procedures applied to you, you need to understand how those arose and make sure that they do not arise again. This is absolutely vital, as if you don't solve those communication problems now you will not be able to be certain that over the next four months you are completing your remediation period to the satisfaction of the program.
You may think that the program has failed in its procedures. Even if you have cast iron evidence to this effect, be very careful about taking these failures up with the program, as that would inevitably antagonise the people who will have to give you positive assessments if you are to complete your residency successfully. If you are not going to take these procedural issues up, you need to put them aside as something in the past, and move on emotionally.
Dealing with feedback
You've been told that you have a problem in reacting defensively to negative feedback. Whether you think this is right or wrong, now you've been called on it you need to deal with it
to the satisfaction of the program.
If you are getting negative feedback, try to turn it into a positive for yourself: "I have been told this thing which I didn't know or didn't focus on, and that means I can now take steps to stop that thing happening again". You also need to reassure a person giving you negative feedback that you have taken it in and are acting on it. You do this by echoing back what you have been told (to show you were listening) and then saying what you will do to put the thing right. So when someone tells you something negative what you say is "I understand that it is a problem that [x happened/I did x]. To put this right in this case I am going to do Y. To make sure it doesn't happen again I am going to do Z." In the right circumstance you might also ask whether the person giving you the feedback wants you to let them know about the follow-up. If they do, then make sure that you follow-up as stated.
When you get positive feedback, you can use it as an opportunity to reinforce positive views of your performance. "Yes, I was reading about that this week and I'm pleased to have applied it effectively in this case", and so on.
You will have to be well-organised and think logically to be able to react this way to all the feedback you get, but it will help you to think on your feet and do a better job all round, as well as demonstrating to your program the progress you are making.
Evaluation and support
You should have a schedule from your program of what you need to do and when to complete the remediation. If so, follow it to the letter. Talk to the people who will be assessing you, to make sure that you understand what they want, and what evidence they will be looking for. Make sure that you are meeting with your assessors regularly, and getting regular feedback from them, to ensure that you are on track. You don't want any more surprises. For the first month or so at least, you should be getting at least weekly feedback from each of the people who will be carrying out a formal assessment on you.
Make sure that you keep full and meticulous records of your activities and achievements during your remediation period. Include all the positive feedback you are getting. If you get negative feedback, record what you have done about it. Towards the end of your remediation period, you may want to consider whether this record is something which could help prove to your assessors that you have satisfactorily completed the remediation period. It is usually more productive to give people evidence in your favour before they make a decision than to try to use that same evidence to change a negative decision after it has been made.
At the end of the remediation period, you need to be in a position where your assessors have enough evidence that they are in no doubt that you have completed it satisfactorily.
Is there anyone, such as a residency adviser, who will not be part of your formal evaluation but who can provide advice and support? Sympathetic attendings or senior residents? Now is the time to ask for their help.
Good luck.
