Residency/Fellowship Programs on Probation (Updated daily) - ACGME

[Light at end of tunnel]

Lots of frustration around these threads about Residency/Fellowship Programs behaving with impunity.

Let's give the ACGME some credit though, surely there are tons of complaints made weekly from medical students/residents across the country. The ACGME has limited resources, so it can only do so much. But, it does put programs on probation and withdraws accreditation not too infrequently. The question is why?

What issues would flag a program to get inspected or whatever its called?

Here's a link to all programs on probation as of TODAY, and its updated daily:

https://apps.acgme.org/ads/Public/R...ntYear=2016&OrganizationTypeId=1&SpecialtyId=

If we could figure out what sort of issues the ACGME actually takes seriously, then maybe we could more precisely express our own frustration in a productive way that can actually stimulate some change.

Does anyone know why these programs are on probation? If you don't feel comfortable posting, I would be happy to post on your behalf.

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[bannie22]

Whats the point. They are all one big entity and residents are completely powerless

 

[Light at end of tunnel]

Knowledge is power

 

[Crayola227]

Knowledge is power

there is no power held by the trainee in this game

 

[tyrionlannister00]

.....

 

[Light at end of tunnel]

Our program always threatens with "If you rank us low on the survey, we'll all be on probation and that's good for nobody!". How do we respond to this? Any thoughts? It is a common thing among our residents when you talk to them about the survey, most of them will say they will mark all "good scores" to avoid probation even though they have complaints.

You make a good point, and probably represent what many of us would think if we were in your position.

From my limited research (mostly done by reviewing the ACGME website) and talking with others, the surveys are meant to assess the program's compliance with acgme "Standards." Basically, are they following the rules or no.

If the responses on the survey direct the ACGME to a specific area, it will generally alert the program and allow the program to address the issue. No program is perfect, and the survey isn't meant to be punitive to a program at all. It's a way to help improve.

However, if there is routine non compliance based on follow up surveys, then the ACGME may place a program on probation. I mean, you want the accreditation? You gotta follow the rules.

As residents/future residents, it sort of is incumbant on us to answer honestly so that we can help our programs improve and make things better for future residents.

Lots of programs coach residents in the sense of clarifying things that may not be obvious. However, they cant tell you how to answer questions and they certainly cant ask you to "lie."

If your program asks you to be dishonest, there may be a much bigger issue they are trying to keep out of the light.

 

[killerleaf]

Basically, the ACGME is looking to see how a program is following the rules, in both letter and spirit. They have to take into consideration the fact that no two programs, even of the same specialty, are going to address the requirements the same. Their mission is stated that they don't want to shut programs down, they want to have programs open and functioning correctly. As long as a problem is identified, and is being addressed, the program is allowed to carry on as is for a while. However, it is when there are multiple problems, with no apparent interest in correcting, that a program ends up on on probation. They also have to balance "he said/she said" between PD and residents and faculty, and try to determine where the truth lies.

 

[dpmd]

I know Kern medical center went on probation for faculty turnover, lack of radiology nighttime support, and inadequate scholarly activity. They stayed on for low board pass rates (with only 2 residents per year it is easy to quickly dump your pass rates with just a few people struggling) as well as issues with ent and plastics weekend coverage and blood bank support and some administrative stuff like rotation paperwork, and protected time for the program director. Not sure if they have been re-reviewed yet.

 

[Light at end of tunnel]

I quote the following because it is relevant to this thread:

I know that for Toledo Jobst it was a combination of things: work hours, poorly structured didactics.

Thank you @LucidSplash

 

[Shikima]

I would equate this effort with what NBPAS is doing against ABMS and the MOC standards.
Encourage all to support this.

 

[LucidSplash]

I quote the following because it is relevant to this thread:



Thank you @LucidSplash

Should be noted this is a fellowship program not a residency program. The list has both residency and fellowship programs on them.

 

[Light at end of tunnel]

Loyola Anesthesiology Program

This is from a post made by @Arch Guillotti, quoting another anonymous member - Thank you Arch. Please note this post was made 2016, and that Loyola anesthesia is no longer on probation, as they are no longer listed on the current list of programs on probation. This is simply to offer some insight into the process.

From a relatively long-term and established member of SDN:

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"I'm a resident at Loyola and yes we are on probation. I'm a long time poster here, but I had Arch post this for me because I'd prefer to keep my anonymity. I think it's better than someone creating an account with one post and not having any legitimacy, but who knows.

The reason we were put on probation was "service over education". Mainly that related to relief of CRNAs and a poor educational curriculum. We never broke duty hours, but there were a lot of times where you'd wait around to relieve a CRNA at 5. In addition, the quality of our lectures wasn't great and you were often pressured to go set up your room rather than attend. The atmosphere is excellent here and the department is well-respected around the hospital. There were no malignancy concerns that led to the probation.

Although we were in fact put on probation, that's actually led to some good changes here. They got rid of the CRNA relief thing and so you no longer have to sit around and wait if you are not on-call. They've also hired more attendings and CRNAs in an effort to further smoothen out the schedule.

In addition, they've added an hour on Wednesday's for educational activity which is protected and you get a late start or your attending starts your case. They've also changed who is in charge of the curriculum and they're revamping the entire lecture series, with more of a focus on ITE and written board prep. So now we have a Critical Care lecture on Monday mornings (optional attendance), Oral board prep Wednesday morning (also optional), class lecture on one of the other days (they changed it where you usually get a late start now) and the Wednesday lecture.

Overall, I know we're on probation but I don't regret coming here one bit and it appears to have motivated the department heads to make significant changes. I ranked Loyola #1 and I would come back here again if given the chance. The pathology that you'll see here is excellent and most residents meet their numbers by the end of CA-2 year. CV surgery is really big here and you get experience with all sorts of hearts. Plus we're a Level 1 trauma center and a major transplant center so you'll get more than enough exposure to large cases. You also do an entire month of blocks and you can get upwards of 200 blocks easily. Didactics and education need improvement, but hopefully those changes will kick in.

Honestly, if you want a program where you're going to be clinically sound and able to do any sort of case, then Loyola will give you that. You're going to have to do some reading on your own, but I knew that coming in and preferred to go to a place that gave me the ability to deal with anything since I know I have the ability to self-study.

If anybody has any questions, please don't hesitate to ask."

 

[dermmom17]

Looking at the above ACGME link, how can you tell whether probationary status is for residency or fellowship? Any way to know which specialty?

 

[Light at end of tunnel]

Looking at the above ACGME link, how can you tell whether probationary status is for residency or fellowship? Any way to know which specialty?

The quick and dirty way is to copy and paste the program and its identification number into google and hit search. That will give you all of that information.

I have considered making that distinction in this thread, but the issue with doing so is that the list of programs on probation changes rather frequently.

 

[NotAProgDirector]

Looking at the above ACGME link, how can you tell whether probationary status is for residency or fellowship? Any way to know which specialty?

The first three digits are specific to the field. "140" is internal medicine, for example.

 

[Light at end of tunnel]

Just as a heads up and reminder, staff members are willing and happy to post anonymously on your behalf if this is a concern. I discussed with @Winged Scapula and made sure this is OK.

Please do keep in mind that all staff members are volunteers, work or study full time, and it may take several days before posts can be made. Also, posts may be edited if they contain TOS violating material.

Confidentiality is important to SDN and staff members.

 

[tyrionlannister00]

.....

 

[pbdoctor1]

Sorry to bring up an old thread but given the focus on physician wellness and suicide prevention a big decision in selecting residency is a big factor and more transparency will help.

There is also a link for access to an updated ACGME residency programs under probation here: ACGME Probation Status that will help guide medical applicants for specific fields and programs. There are a total of 18 so far in 2018. I would clarify and ask why and what has transpired and then make a better judgement if you're willing to take that risk especially if a program shuts down. It is very hard for a residency to be on probation and very hard to change the culture of a residency program.

Good luck everyone. Becoming physician is a long road and supporting each other is important.

Maybe more physicians will come forward and share their experiences before they quit, burnout, become fired, or worse blacklisted and banned by program directors from a malignant residency and never become a physician. There are plenty of great programs and supportive program directors that are focused on resident wellbeing and education, find them!

 

[studentlounge]

Albany Medical Center Neurology Program was on probation last year that has been lifted. The trigger was a combination of bad surveys and board failure rate. There were also problems with many duty hour violations, no protected time, no true back up system, poor or lack of overnight attending supervision and attending failure to show up to give their own lectures.

Faculty turn over is frequent, with 7 departures in the last 4-5 years, including the chairman. Some faculty members have failed neurology boards multiple times (still teach residents). New secretaries often don’t make it to their lunch break on their first day of work before quitting.

To improve, the residency increased by 1.5x, replaced single person 24h calls with 2-person night float, and the PDs do many of the lectures themselves. The program held a session to coach the survey. Residents were aware that program termination wouldn’t go well for them, so were/are eager to help the residency get back on track. The PDs plan on buying senior residents a board review course this year. Issues with protected time and overnight supervision are still being figured out. The chairman recently left, leaving the PD as interim chair and associate PD as interim PD. Hopefully, new leadership will bring this program to heal.

 

[Crayola227]

lol I love how one area was improved by "coaching" the anonymous survey under the threat of possible career termination

never change, residency

 

[Limvostov]

lol I love how one area was improved by "coaching" the anonymous survey under the threat of possible career termination

never change, residency

This is all too common a culture. The threat of shutdown for bad reviews is real. Also retaliation is real especially in a smaller programs because we're all smart and if there are only a few reviews coming in it's easy to identify who wrote which review or even just penalize the whole cohort. I just remind myself daily to keep my head low, don't associate with people who complain, always give positive and constructive feedback, focus on my goals, and realize there is life after this process. I have found fellowship much easier than residency following these steps. My time in fellowship has been much more smooth.

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[dyeguy21]

lol I love how one area was improved by "coaching" the anonymous survey under the threat of possible career termination

never change, residency

To be fair, there are some questions on the survey that use the "official wording" and your program may call the thing they are describing something else. For instance, ours had a 0% on "attending coverage on night float," we call them nocturnists and we have like 6 available at all times, however, the residents thought it meant their team's attending and thus answered "Never."

 

[Siggy]

To be fair, there are some questions on the survey that use the "official wording" and your program may call the thing they are describing something else. For instance, ours had a 0% on "attending coverage on night float," we call them nocturnists and we have like 6 available at all times, however, the residents thought it meant their team's attending and thus answered "Never."

That recently happened at the IM residency at the hospital my CC fellowship is at. Probation due to bad reviews and it was remediated by replacing the DIO and PD AND telling the residents, "When the survey asks X, they are specifically talking about Y... which is covered by Z.

It's like asking about procedures. As a fellow, all of my procedures are supervised. The attending being in the hospital and readily available if there's an issue is simply a different level of supervision than in the room providing direct supervision.