question about residency evaluation

[paintstick]

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Gang,
With enough recent posts about withdrawals and firings to cause some acute MIs in rising PGY-1s (myself included), i was wondering if some of you could post what is a more "normal" semi-annual and year end resident review like?

Specifically, I have read about the portfolio system and ACGME core competencies, but i was wondering how difficult these portfolios are to put together (and what exactly goes in them) and how they are actually used in evaluation.

Finally, was degree of "career development" occurs during meetings with PD. I am optimistic to think that a part of the time you meet for your reviews is based on career aspirations and how to achieve them and not just solely on all of your shortcomings, but....is this purely an optimistic view?

Any insight on how the meetings have gone for those not being forced out of their positions would be greatly appreciated.


have a great day

 

[Droopy Snoopy]

Gang,
With enough recent posts about withdrawals and firings to cause some acute MIs in rising PGY-1s (myself included), i was wondering if some of you could post what is a more "normal" semi-annual and year end resident review like?

Specifically, I have read about the portfolio system and ACGME core competencies, but i was wondering how difficult these portfolios are to put together (and what exactly goes in them) and how they are actually used in evaluation.

Finally, was degree of "career development" occurs during meetings with PD. I am optimistic to think that a part of the time you meet for your reviews is based on career aspirations and how to achieve them and not just solely on all of your shortcomings, but....is this purely an optimistic view?

Any insight on how the meetings have gone for those not being forced out of their positions would be greatly appreciated.

have a great day

Seriously, don't stress about it. 99% of residents will have no problems going straight through. My own experience (which I suppose may be considered 'normal'): Just for background our program has a faculty 'mentor' meeting assigned at 3 months and prn thereafter for coordinating research projects, various issues that you might have questions with that require >chief but <PD level advice/action, etc. At 6 months and then 1 year you meet with the PD, then annually thereafter to graduation.

My meetings are always laid back and pretty much formalities -- ACGME says you gotta have 'em. We'd go over in-service scores, conference attendance, pending research, career goals, other mandatory stuff (have you taken Step III, did you get your NPI#, are you UTD on vaccinations, etc.). We'd go over evals, make some smalltalk about our respective families or college football teams and that'd be it, 20 minutes.

Block-to-block evals and other training review tools utilized to evaluate residents are typically similar to what you've probably already encountered. The difference is they're generally less BS because you're working much more closely with the evaluators such that they get a more accurate picture of strengths/weaknesses. You can be the dumbest, laziest medstud in the world and, as long as you don't make a lot of waves and have some general people skills you'll typically skate through with a high pass.

Not so as an intern. If you're not up to par it becomes painfully obvious pretty early because things get missed. Your patients bounce, your upper-level is constantly sharing your workload, your staff pulls you aside, you get 'targeted' in conference, etc. I mean your first 1-2 evals will 'normally' be a little rough around the edges as you're hiking up that steep, steep learning curve (especially if you were like most people and basically did nothing second half of M4 year), things should normalize after that. Certainly by Christmas you'll have found your groove, at which point your meeting with the PD should be about what I described above.

 

[notinkansas]

I think the "normal" evaluation will be fine. Depends on exactly how it's done, but most attendings will rank you at average to somewhat above average, depending. You may have a handful of points that need improvement. In my surgical residency, there were a number of areas that were ranked on a 5 point scale (1 is lowest). The points would be things like notes, presentations, clinical decision making, interactions with patients, preparation for OR, etc.

Most of the time, it seems like the attendings would pretty much just fill in number 3 (which meant that you were at the expected performance for your PGY level) There would be a few who would give you higher scores, and a few who would rank you a little lower on a couple points, but the program then averaged it all up. As long as your average was 3 or better, you were fine. And it was rare for this not to happen. In surgery, anyway, it is more common for a weaker resident to repeat a year than to be kicked out.

I would look at the stories of residents getting kicked out of programs the same way you look at new reports of plane crashes. They make big headlines, but ultimately only a very small percentage of the flying public dies in a plane crash. And only a very small percentage of residents get kicked out, or otherwise don't complete their original program.

 

[dragonfly99]

It depends on your program. Most PD's are fairly nonconfrontational and not looking to harm you. Some have better people skills than others, or are just better at giving positive and negative feedback that is helpful. In general I found feedback from attendings that I actually worked with 100% more helpful than any I ever got from the PD, as he didn't have any experience ever working with me. He was basically just reading off of other people's evaluations.

At my program the interns met with the PD Q3 months, and upper levels just twice/year. Usually he just went over the attending evaluations, just the positives/negatives, more so the negatives. There wasn't small talk or any discussion about research. We didn't have faculty mentors or research mentors, which apparently residents do have at some places. We didn't have a buddy-buddy relationship with our PD, but the culture differs according to where you train. I found these meetings less stressful as residency wore on, as the PD tended to fixate on interns versus leaving the upper levels alone...LOL!

I agree that residents getting fired is pretty rare. Depending on your program and specialty, having tense or more intimidating meetings with a PD or other attendings may be rare or not rare. As long as you don't seem to fall outside the norm for your program, you don't have cause to worry. If you find you're getting a lot of negative feedback but nobody else seems to be, then you should start worrying.