Residency Probation

[hydrochlorodieinside]

Hi everyone,

I was recently put on probation in my residency and was wondering if anyone had any experience or advice while on residency probation? My anxiety is through the roof and what's left of any self esteem I had is now gone. It worries me knowing that by the time they re-evaluate me next month I could possibly be terminated despite having two more months of residency left.
I am a PGY2 (did PGY1 somewhere else) and there's a few concerning things about my progress that caused me to be in this predicament. This was all exacerbated when I was unprepared for a topic discussion. There's no excuse but the reason I was unprepared was because it fell on the same day I had to present grand rounds and I spent the entire night before preparing for grand rounds instead of reviewing the topic. Because I wasn't ready for a topic discussion this was essentially missing a deadline which my program takes extremely seriously as it reflects professionalism. Another concerning thing is after a rotation I am unfortunately not hitting enough "Achieved" on PharmAcademic and only getting "Satisfactory Progress". Like any residency, you need 75-80% "Achieved" by the end of the year to pass. Upon receiving this news, I am now waking up at 5 am and on some nights spending time in the office until Midnight working on projects/research/topic discussions to be completely prepared. I am so anxious to know what will be next month. Has anyone had any experience in this or could shed some advice? Thank you

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[KidPharmD]

The only think I can say is that you have to work your hardest.

I will say that if you are worried about SP vs Ach - Your program is using Satisfactory Progress wrong. SP means that you are where you are supposed to be at that point in the year but still have something to learn before your end-of-year goals (achieved). They shouldn't be marking SP if they think you are behind.

The reason I think it is hard to give you advice, is that I think your program has failed you a bit if you were surprised by this probation. Either they knew you were struggling and did nothing about it or you were doing fine and they have had an extreme overreaction to missing a deadline (which I am sure they never do ).

 

[ethyl]

Did you get NI for anything yet? The term probation seems pretty harsh but “failure to progress” should certainly be concerning. Starting the ordeal with missing a topic discussion may seem like it’s minimizing the magnitude of issues, which may be efficiency and prioritizing. Are there med errors mixed in too? Have you reflected on what you could have been done better to meet deadlines or at least communicated a request to delay a deadline? It’s tough at this point to excel because many will fall in the rut of wanting to check the boxes to make sure you achieve learning objectives instead of trying to be a true part of whichever team you’re working with and maximizing your impact on taking care of people.

 

[Rockinacoustic]

You need to sit down with your RPD and develop a learning plan moving forward. It is not in their interst to fail you, but you need to take onwership of your time management and work to move deadlines if you're not going to deliver. No one can help you if you aren't asking for it.

 

[hydrochlorodieinside]

Thanks for the reply all. My RPD worked hard and we did develop a weekly learning plan to move forward. Unfortunately I tried my hardest but it has been decided that I will not be receiving my certificate at the end. They did offer to let me continue with rotations until June and still be paid; so that's nice in terms of having a salary to be able to pay rent/bills. I'm calm and accepting of all of this now but it was only after days of being extremely depressed.
During my probationary period I had to meet deadlines and I did; I completed and submitted my research abstract and poster, I was prepared for all topic discussions and I completed and finished multiple presentations (early enough to receive multiple feedback revisions and practice runs). I checked so many boxes in terms of projects/presentations that I am pretty much done in that department for the residency. My RPD is aware of how hard I have been working and commended me on this. What made me not advance is inefficiency and inconsistency in pre-rounding and working up patients in terms of identifying drug-related issues. I simply was not able to catch issues that my RPD explained should be "second nature" by this point. While I tried my hardest and woke up incredibly early to be as thorough as possible when working up patients, it was difficult for me to fix this as I didn't know what I didn't know. I also explained to my RPD that this was all very surprising as I never had a "Unsatisfactory progress" or any alarming evaluation comment until mid March where suddenly I'm failing and, in my view, too late to fix a knowledge deficit. I was always told by preceptors that I'm doing fine and during quarterly meetings I was never told any alarming or concerning comments. It's all very disappointing and even embarrassing to show my face, but I will continue to stay and learn despite no certificate in the end. While it may be difficult to move forward career wise by having a 'failed' residency on my CV, I'm trying to stay positive in knowing my career is not over.

 

[sadface]

May I ask what the pgy2 was in just out of curiosity?

 

[hydrochlorodieinside]

May I ask what the pgy2 was in just out of curiosity?

Critical care.

 

[Rockinacoustic]

Thanks for the reply all. My RPD worked hard and we did develop a weekly learning plan to move forward. Unfortunately I tried my hardest but it has been decided that I will not be receiving my certificate at the end. They did offer to let me continue with rotations until June and still be paid; so that's nice in terms of having a salary to be able to pay rent/bills. I'm calm and accepting of all of this now but it was only after days of being extremely depressed.
During my probationary period I had to meet deadlines and I did; I completed and submitted my research abstract and poster, I was prepared for all topic discussions and I completed and finished multiple presentations (early enough to receive multiple feedback revisions and practice runs). I checked so many boxes in terms of projects/presentations that I am pretty much done in that department for the residency. My RPD is aware of how hard I have been working and commended me on this. What made me not advance is inefficiency and inconsistency in pre-rounding and working up patients in terms of identifying drug-related issues. I simply was not able to catch issues that my RPD explained should be "second nature" by this point. While I tried my hardest and woke up incredibly early to be as thorough as possible when working up patients, it was difficult for me to fix this as I didn't know what I didn't know. I also explained to my RPD that this was all very surprising as I never had a "Unsatisfactory progress" or any alarming evaluation comment until mid March where suddenly I'm failing and, in my view, too late to fix a knowledge deficit. I was always told by preceptors that I'm doing fine and during quarterly meetings I was never told any alarming or concerning comments. It's all very disappointing and even embarrassing to show my face, but I will continue to stay and learn despite no certificate in the end. While it may be difficult to move forward career wise by having a 'failed' residency on my CV, I'm trying to stay positive in knowing my career is not over.

Sorry this is happening. I'm a bit suspect that if you were put on probation, met the requirements of your learning contract, and will still be declined a residency certificate. Also curious what knowledge deficits are so egregious they weren't communicated to your before your meeting to decide your fate. We do only have your side of the story though.

Legally, there should be something in your residency handbook that defines what constitutes failing a resident and denying completion. Make sure your program followed those steps as outlined. Consider contacting ASHP if this is an accredited program for advice on what recourse (if any) you may have. Don't sign any acknowledgement of this decision until you've investigated your legal options. @confettiflyer may have some thoughts on this.

Overall, it's not the end of the world - I've interviewed and seen people hired who did not complete their PGY-2. Make sure it's justified through.

 

[sadface]

CC was my guess based on other interactions I’ve had with CC pharmacists for whatever that’s worth

 

[BidingMyTime]

How do they go from putting you on probation, and then 2 weeks later telling you you won't get your residency certificate? A 2 week probation is nor normal or reasonable. The fact that you are going to work out your contract, tells me they aren't concerned about patient harm, so why would they not work with you over the next 2 months to help you meet all the standards you need to get your certificate?
Either your residency is very toxic, or you aren't telling the whole story.

 

[Hels2007]

Yes, something is not adding up there. If you were getting satisfactory progress for eight months and then suddenly in March it's all about you being unable to identify drug-drug interactions all along? Two weeks from probationary status to 'no certificate for you'? I have no experience with residencies, but the only time I have heard of things like that is when the organization really wanted to get rid of the individual in question and do that ASAP. But that's inconsistent with them letting you stay through June. What's the missing piece?