Program asking to Repeat

[sudandoctor]

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My im program is asking me to repeat 4-6 months of 1st year before i can move on to the 2 nd year. They are saying they wont give me good LORs as well so i can quit and try in another program. does anyone who have experience in this situation , please share any info how to go about handling this... A few months back they did ask me to try in another program but unfortunately didnt get make good decision at that time and did not agree to that and said I want to stay in the program....

please advise!!!

Thanks
Doc.

 

[Smurfette]

You need your program to say you successfully completed your PGY1 year to get a PGY2 spot somewhere else. i.e. your new program can only give you credit for "time served" if your old program gives you the same credit.

Since your current program is telling you that you need another 4-6 months to remediate, your options as I see it are:
1. stay in your current program and repeat the 4-6 months before they advance you to PGY-2. Then you could a. stay there for the rest of residency (if they'll keep you) or b. transfer out to complete residency elsewhere after getting enough credit to start elsewhere as a PGY2.
2. Look for a new program but realize you'll probably have to repeat the ENTIRE PGY1 year (they may give you a few months credit, but it's at their discretion....and if your current program gives you poor LORs, your odds of finding a program to take you AND give you credit for some of your PGY1 year are low).

If a program asks you to leave/find a new program, that's a bad sign. At that time they were probably willing to help you out to find a new program. If they're now saying they won't give you good LORs or support you, things are going to be very tough for you.

Best of luck.

 

[Buzz Me]

Agreed that if they're asking you to repeat 6 months, you're likely not going to get a good LOR from them if you were to try and transfer.

Did they state why you needed to remediate?

 

[Winged Scapula]

Hmmm...this is very concerning.

Smurfette has outlined your options well.

But I have to suggest that if your program wants you to remediate 6 months and is refusing to give you a good LOR, I would be suspicious that they have no intention of keeping you around after those 6 months of remediation.

Of course, without a letter stating you are in good standing, your chances in another program are slim to none, so you probably don't have many options other than to stay, work your arse off, get a year of GME under your belt and possibly get at least a decent LOR.

 

[Doctor4Life1769]

What's the reason for the remediation?

What specialty are you?

Are you a US grad or FMG/IMG?

Just curious, about to start residency myself, so stuff like this kinda freaks me out 🙁

 

[TexasPhysician]

You need to repeat those rotations. There is no other good options that I know of.

 

[NotAProgDirector]

Actually, from here it sounds like your program is giving you the best shot you've got.

To review, it sounds like they had concerns about your performance 6 months ago. They discussed with you whether switching to a new program made sense. Sometimes that is helpful. I'm guessing you're an IMG from your screename and grammar. It's possible that a different program might have a different style, different work strcuture (i.e. overnight call vs night float), or may simply have more people from your cultural background such that it might improve your chances of success.

You decided to stick it out, which is not an unreasonable decision. However now they are extending you by 6 months. They could simply fire you now -- your contract is up in June and they do not need to keep training you. So, sounds like they think you've made some progress and are willing to give you more time. Having an off cycle resident like this is difficult for programs -- they count against our caps for funding and training, so sometimes it requires downsizing a resident slot elsewhere.

Let's be clear about what a "good LOR" is. If the OP is looking for a letter saying they were totally fine as a resident, that's clearly not going to happen. The best they could hope for is a letter documenting their deficiencies, and how they have improved, and what they are doing to improve. I agree that would never get you a PGY-2 spot elsewhere. So, looks like you could continue in your current program for 6 more months of PGY-1, or try to find another program with an open PGY-1 spot for 12 more months. If you really are struggling, the more time you have, the better.

If you stay, here's how it will play out:

I would reassess your performance in 3 months. If you hadn't made significant progress such that I thought that in another 3 months you'd be ready for PGY-2, I'd tell you that your contract would end at the end of 6 months. This would give you 3 months to do electives, and otherwise try to restart your career.

Make sure you understand the gravity of the situation. If your performance does not improve to promote to the PGY-2 year, you will be fired in 6 months.

 

[Law2Doc]

...
But I have to suggest that if your program wants you to remediate 6 months and is refusing to give you a good LOR, I would be suspicious that they have no intention of keeping you around after those 6 months of remediation.
....

Agree with this and aPD's synopsis. Your program is doing you a favor in not firing you outright for what they perceive to be deficiencies. They apparently like you enough to give you another 6 months to progress enough that they will feel comfortable saying you satisfied the requirements of their intern year. Most programs aren't comfortable saying someone awful satisfied their intern year accomplishments, effectively passing a problem onto another program, but if you do a good enough job in another 6 months, they probably will be more comfortable doing so. But I wouldn't have high hopes of getting your contract renewed by them after that, just a "best of luck" as a PGY-2 somewhere else.

 

[shopsteward]

Please put out of your mind any idea that you should have changed programs all those months ago. Wishful thinking at this stage about how something else would have been better than where you are will not help you. And it is by no means certain that it would have been better. You would have had to join a new program under the cloud of failure at your current one, and there is no certainty that you would have found another program to take you. Also, now that you are trying to carry on where you are, it is in your favour now that you have shown commitment and "stickability" to your current program.

As to the remediation period you have been offered at your current program, you are going to have to change things if you are to demonstate your success in completing it. You can't change your program, so the only thing you can do to demonstrate your success is change yourself. That means changing both your attitude and what you do. You may feel that both your attitude and what you do have been fine in the past, and that the situation you are now in is unfair. It would be very natural for you to think that: you wouldn't have got as far as you have without being intelligent, hard working and ambitious. But you are now in a situation where you need to be able to convince others of your abilities, so you need to act in a way which convinces them that you are a good doctor.

If you are not going to have a positive approach to the situation you are in, and make the changes to your attitude and to what you do so which convince your program that you are a good doctor, you might as well give up now.

Having decided to stick where you are, and to change yourself, the question then is: what do I need to change and how do I do it? To answer this, you need help from someone who knows what the specific issues are for you and the situation you are in. When being told about the remediation, were you given a supervisor, someone in charge of your assessment for the period? If so, talk to them about what they want to see from you over the period. Make sure you understand what they think your problems have been, and what it is they want to see changed. Break down what they want into small chunks, and work at producing proof that you have met each requirement, documenting as you go. Make sure you have regular checks with them on your progress, probably no less than weekly, so you can be sure they are happy with the way things are going. You need to produce proof that you are doing what it is they want. If you produce that proof, you will pass your remediation.

Make sure you understand who in the organisation will be checking your progress and having input into your evaluation by the program. This will potentially be a lot of people. You need to prove to all of them that you are doing what is needed to pass your remediation.

Do you have a resident adviser that you can talk to? Someone in the organisation who knows the program and will be on your side rather than a part of the hierarchy? If so, you need ask for their help, and to be talking to them on a regular basis.

Good luck.

 

[sudandoctor]

Thanks everyone for replying!!

The issue here is not as much as what my deficiences are, the issue is negative stereotyping by folks in the program, all my colleagues say I am one of the better residents there but some folks cant seem to digest it and are on a path to destroy my reputation in the program. Due to this issue I have been asked to remediate. Is it worthwhile to involve CIR/acgme at this stage to see if they can be of any help?

Thanks
doc

 

[michaelrack]

Thanks everyone for replying!!

The issue here is not as much as what my deficiences are, the issue is negative stereotyping by folks in the program, all my colleagues say I am one of the better residents there but some folks cant seem to digest it and are on a path to destroy my reputation in the program. Due to this issue I have been asked to remediate. Is it worthwhile to involve CIR/acgme at this stage to see if they can be of any help?

Thanks
doc

That attitude- that you don't have deficiencies- is not going to help you right now, even assuming it is true.

 

[michaelrack]

That means changing both your attitude and what you do. You may feel that both your attitude and what you do have been fine in the past, and that the situation you are now in is unfair. It would be very natural for you to think that: you wouldn't have got as far as you have without being intelligent, hard working and ambitious. But you are now in a situation where you need to be able to convince others of your abilities, so you need to act in a way which convinces them that you are a good doctor.
.

👍

 

[Arcan57]

Thanks everyone for replying!!

The issue here is not as much as what my deficiences are, the issue is negative stereotyping by folks in the program, all my colleagues say I am one of the better residents there but some folks cant seem to digest it and are on a path to destroy my reputation in the program. Due to this issue I have been asked to remediate. Is it worthwhile to involve CIR/acgme at this stage to see if they can be of any help?

Thanks
doc

The disconnect between your perception of your clinical competence and the program's is going to make this end badly for you. It's like someone with hemi-neglect trying to rehab their left side, the lack of awareness doesn't allow them to participate actively in their recovery. If you persist in acting like you're being discriminated against unfairly, you will be fired. If you have hard evidence of a pattern of discrimination and numerous coworkers willing to back you up, then 5 yrs down the line you MAY win a lawsuit.

It feels like you're being singled out because you have been. The rest of your class is advancing to PGY-2 year, and you've been identified as not prepared to make the same advancement. Your peers are (mostly) going to tell you what social nicety requires, which is they don't know why the bad, evil administration is trying to ruin you. I'm sure you feel that anyone that's said otherwise has been your enemy from the start and why would you listen to your enemies? Take it from an anonymous stranger on the Internet, drop this persecution belief and address the deficiencies cited by program. Anything else is going to be a short ride out of medicine.

 

[Law2Doc]

Thanks everyone for replying!!

The issue here is not as much as what my deficiences are, the issue is negative stereotyping by folks in the program, all my colleagues say I am one of the better residents there but some folks cant seem to digest it and are on a path to destroy my reputation in the program. Due to this issue I have been asked to remediate. Is it worthwhile to involve CIR/acgme at this stage to see if they can be of any help?

Thanks
doc

What you think personally and what your colleagues tell you to your face may not reflect what the people that matter think. Nobody is out to "destroy your reputation". You have shortcomings, at least in their perception, and you are being given a chance to remediate. Do your best to own up and fix these problems. Putting your head in the sand and saying, "it's not me, these folks are out to get me" is in itself a big problem for a resident. You need to learn from criticisms, not fight back. Most of the time as a resident you are wrong. Even when you are right, you will still be wrong if you take the "they are out to destroy me" attitude. I'm sorry but you are simply not important enough that any of your bosses will feel the need to destroy you. They won't let you skate by, but anything that causes you to be destroyed will be your own unwillingness to fix things.

 

[NotAProgDirector]

Agreed with all above. The attitude displayed in your post will certainly get you fired, regardless of what the problem actually is, and is a key reason why your program won't give you a "good LOR".

No one has addressed your ACGME/CIR question directly, so I will.

Contacting the ACGME is a Complete Waste of Time. The ACGME accredits programs. It does NOT investigate complaints of residents being treated unfairly, unless you have complaints about duty hour violations or your program clearly violating one of the core rules of residency program management. They don't want to hear your gripes, and will not address your issue.

If your program has a resident union represented by CIR, then they may have an ombudsperson to help mediate problems like this, and you should definitely contact them. If your program does not have a union, then CIR has no standing (and you don't pay any dues) and hence won't help you at all.

 

[dragonfly99]

ACGME will not help you.
Agree w/above comments, particularly Shopsteward.
It doesn't matter whether some of your perceived deficiencies are true deficiencies or not. The higher ups now have the microscope on you.
It looks like you are an FMG (based on your screen name and grammar of your post). This would make it harder to get a 2nd residency in your situation if you quit or get fired. Your best option is to stick it out. To do that you have to address some of your deficiencies (real and/or perceived by others). Other residents are not going to tell you whether you are good or not...they won't tell you to your face if you are making mistakes, etc., at least for the most part. Particularly your friends will not...they want to be nice.
If there are any faculty members, or a chief resident, that you are friendly with, try to get some feedback on what exactly you can do to improve. Is it organization, versus interactions with colleagues or patients, versus some questionable decision making (medically speaking), etc. etc.

In this situation it doesn't matter (as far as the final outcome) whether or not all your "deficiencies" are true or not, in your estimation. If you get fired or try to go to another residency you are very unlikely to ever get another one in the U.S. You need to make it in your program or you're not going to make it through. Even if you don't like some of the people above you, or you feel like you are being treated unfairly, you have to suck it up or you're going to get fired.

 

[sudandoctor]

Wanted to take advice of any PDs out here:

What are my chances to get into another program in pgy 2 if the PD writes I need repetition in my lor and that I do get credit of the 1st year with marginal grade? what is my best shot to get into another pgy2 here?

I got really good lors from other attendings however which seem to be contradicting the other one.

please advice!!

-Sudan

 

[gutonc]

Wanted to take advice of any PDs out here:

You got it 2 posts above yours. Pay attention to it.

What are my chances to get into another program in pgy 2 if the PD writes I need repetition in my lor and that I do get credit of the 1st year with marginal grade? what is my best shot to get into another pgy2 here?

Poor at best. You might have a better chance with a PGY1 spot but this is still not guaranteed.

I got really good lors from other attendings however which seem to be contradicting the other one.

Doesn't matter. If the PD letter says you're not ready to move up, you're not ready to move up.

 

[CambieMD]

Hi Sudandoc,
This post is also aimed at those who will start their residencies later this month.You need to seek honest feedback from the staff at your residency program. You must accept the feedback that you receive and try not to argue or explain yourself. No residency program wants to fire a resident if they do not have to. The implications are dire for all involved. Divorce yourself from the thought that this is unjust. Move forward with the goal of saving your career.

I run into residents who have no idea how they are performing. They think that eveything is great. Programs are poor at giving useful feedback when it can help. The flip side is that many residents are in denial.

Residents have to seek feedback. They should ask thier attendings how they are doing. If a resident sees a problem in their performance they should attempt to remediate themselves. Discuss your weaknesses as you perceive them with attendings and seek to fix them. Keep a journal of your progress.

Strong residents walk up to me and ask me what they need to do in order to stay strong. The wilingness to seek feedback seems to be a trait of those who are performing well. This speaks to self awareness.

At the start of my second residency, I felt that I was not as comfortable a quick as my colleagues. I went to my adviser and discussed my concerns. I asked him to work with him for a week. He observed me and told me,"everything," that I did wrong. This turned things around for me.

A resident may think that an issue is a small deal but the program may see it as a deal breaker. Seek feed back early on.



Cambie

 

[sudandoctor]

You got it 2 posts above yours. Pay attention to it.



Poor at best. You might have a better chance with a PGY1 spot but this is still not guaranteed.



Doesn't matter. If the PD letter says you're not ready to move up, you're not ready to move up.

I did notice it but wanted to make sure I get their input on this one in particular.

 

[Law2Doc]

I did notice it but wanted to make sure I get their input on this one in particular.

The advice isn't going to change. If your own PD takes the position that you need repetition, no other PD is ever going to write that off and hire you as a PGY-2. Nobody wants to assume someone else's headache. Other faculty letters are well and nice, but the bottom line is that the PD's word is the one other PDs are going to look at. You really have no realistic choice but to at least attempt to satisfy your programs PGY-1 requirements to the satisfaction of your PD.

 

[CambieMD]

The advice isn't going to change. If your own PD takes the position that you need repetition, no other PD is ever going to write that off and hire you as a PGY-2. Nobody wants to assume someone else's headache. Other faculty letters are well and nice, but the bottom line is that the PD's word is the one other PDs are going to look at. You really have no realistic choice but to at least attempt to satisfy your programs PGY-1 requirements to the satisfaction of your PD.

This is should be the end of the discussion for now. There is no way around what your program wants you to do. You will hurt yourself further if you try to force the issue.

Cambie

 

[sudandoctor]

For what its worth, what option do I have if they had given me the next year pgy2 contract couple months earlier but changed their mind and asking me to repeat now? Does that make sense, maybe? any comments please?

Thanks!!
doc

 

[MrBurns10]

For what its worth, what option do I have if they had given me the next year pgy2 contract couple months earlier but changed their mind and asking me to repeat now? Does that make sense, maybe? any comments please?

Thanks!!
doc

If your program director wanted you to repeat the whole time, your only option is to remediate.
If your program director changed his mind and now wants you to repeat, your only option is to remediate.

In other words, your only option (realistically) is to remediate however he feels is necessary. After you successfully do so, then you can start thinking about a couple different possibilities, including staying in your program and transferring.

 

[Arcan57]

For what its worth, what option do I have if they had given me the next year pgy2 contract couple months earlier but changed their mind and asking me to repeat now? Does that make sense, maybe? any comments please?

Thanks!!
doc

If the contract wasn't executed then you have no recourse. If it was executed, then I'm sure there's language in the contract about performance and remediation.

I'm going to say this once more. Stop looking for loopholes and do what your PD requires You're a poorly performing resident and on your way to being fired. Unless you change your performace in specific and measurable ways (which have been/will be) laid out by your PD, your PD has the right (and possibly obligation) to not advance you. Nothing is going to change that fact. And very few programs (and no good programs) are going to want a resident that was fired for poor performance and has no insight into why they were fired.

It's June. If you haven't gotten your act together as an intern then why should you be inflicted on the poor interns that you'd be team-leading next month? This is not "my whole family died" or "I had to undergo 4 rounds of chemo" as a reason for being remediated, this is you not being able to convince your PD that you'll be a competent physician. So knock off whatever maladaptive defense mechanism you've thrown up and save your career.

 

[NotAProgDirector]

The advice you are getting on this thread is spot on.

Trying to get into a PGY-2 elsewhere is a bad plan. First, as mentioned, it's very unlikely that a program will take you. Your summative evaluation states you're not ready for a PGY-2 position, so it seems hard to believe that a program would take you as a PGY-2.

Let's look at it the other way. Imagine a program is on probation from the ACGME and is threatened with closure. They have an open position and offer it to you. Would you transfer in? It would be a real risk for you -- if the program closes, your career may simply end.

More importantly, transitioning to a new program (where you know no one, new EMR, new systems, etc) and transitioning to PGY-2 when you now are in charge of supervising interns is a really tough leap. If you're struggling at all now, it's a certain recipe for failure.

Continue as a PGY-1 in your current program, or try to find a new PGY-1 position. Those are your choices. The latter is more difficult, as many programs will not want to take someone who is not doing well in their current program.

 

[CambieMD]

If the contract wasn't executed then you have no recourse. If it was executed, then I'm sure there's language in the contract about performance and remediation.

I'm going to say this once more. Stop looking for loopholes and do what your PD requires You're a poorly performing resident and on your way to being fired. Unless you change your performace in specific and measurable ways (which have been/will be) laid out by your PD, your PD has the right (and possibly obligation) to not advance you. Nothing is going to change that fact. And very few programs (and no good programs) are going to want a resident that was fired for poor performance and has no insight into why they were fired.

It's June. If you haven't gotten your act together as an intern then why should you be inflicted on the poor interns that you'd be team-leading next month? This is not "my whole family died" or "I had to undergo 4 rounds of chemo" as a reason for being remediated, this is you not being able to convince your PD that you'll be a competent physician. So knock off whatever maladaptive defense mechanism you've thrown up and save your career.

This is the best advice that anyone could give you. Your insight is very poor. A lack of self awareness is one of the halmarks of poor performers. They exhibit poor reasoning and never get ,"it." Please prove me wrong and begin making constructive moves towards getting your career back on track.

Cambie

 

[sudandoctor]

Thanks for all your responses, really appreciate it!

I have decided to stick it out and go with the remediation. Please share any inputs, areas to watch out for to prepare myself for the repeat mode. I want to do my best in this stage and not screw up. Particularly regarding dealing with seniors/expectations from management etc. If there are any other areas I need to be careful about as well, please feel free to point. Again, thanks for all your help!

Thanks
Sudan

 

[markglt]

you are totally out to lunch buddy
...please

 

[Law2Doc]

Thanks for all your responses, really appreciate it!

I have decided to stick it out and go with the remediation. Please share any inputs, areas to watch out for to prepare myself for the repeat mode. I want to do my best in this stage and not screw up. Particularly regarding dealing with seniors/expectations from management etc. If there are any other areas I need to be careful about as well, please feel free to point. Again, thanks for all your help!

Thanks
Sudan

The best way to deal with seniors/PD expectations is to nicely ask them where you are falling short and in what areas you need to improve. Then fix it. And don't fight about it, even if you strongly disagree with the assessment. Good luck.

 

[sudandoctor]

The best way to deal with seniors/PD expectations is to nicely ask them where you are falling short and in what areas you need to improve. Then fix it. And don't fight about it, even if you strongly disagree with the assessment. Good luck.

Thank you Sir!!