Totally agree. Hell, there are IM residents who do horribly and still get promoted, and they are closely followed by program leadership to correct any incompetencies. But to dismiss a psych resident bc they “failed” an IM rotation? Doesn’t make sense. They must have not shown up, were unprofessional, etc. Can’t be performance based, heck IM residents accidentally kill patients all the time (all part of “learning,” smh) and yet they aren’t dismissed either. Something isn’t right here with this program...or, the resident must have really did something egregious to the point of reaaaaaaally pissing off leadership.
Idk where you did residency, but this certainly isn't the case where I'm at. Sure, there are the few cases where this happens, but oftentimes it's something that the whole team, including the attending, missed that led to the outcome. If we had IM residents actually killing patients d/t lack of medical knowledge or ability to function, they'd be gone asap.
We don't know what the standards for J Rod's programs were or the individual residents. The attendings I talked to on IM said they expected off-service residents to be able to function as solid Sub-i's, learn some things, and help the team be efficient. They weren't expected to be as good as the IM residents, but they better be functioning better than the M3s. Unfortunately, I have encountered one or two residents (while in med school) that made me wonder how they got into residency or even graduated med school. Yes, they exist, and I don't think dismissing ANY resident who couldn't even pass an IM rotation after 2 tries is that outrageous. If anything, it may be a sign that a program expects their residents to at least live up to a minimal standard of care.
I’m very much in agreement with you. But it’s quite difficult to escape the role of the village idiot when everyone else, having had several months of experience by now, is way ahead of you. You have to put in a lot more effort at this stage because there’s not really the hand holding you get at the beginning of intern year and senior residents/attendings often seem to forget you’re doing this for the first time. Don’t get me wrong - I’m trying to make the most of it. I just mean that it’s increasingly difficult as the year progresses.
It is a tough situation, and my advice may not be that great as I was lucky enough to start residency on my IM rotation so the IM interns were just as clueless as I was. It's not that hard to be successful on a reasonable IM rotation though (that means seeing up to 10 patients a day with adequate support). Make sure you're learning how to treat the most basic/common stuff: HTN, COPD, pneumonia, HLD, etc. Learn about the common meds for these issues which you will almost certainly encounter in a large percentage of your psych patients and how they interact with psych meds. You may need your co-residents and senior to cover for you if you get overwhelmed, that's okay. If that happens, help them take care of the menial stuff that takes up their time (ordering labs, placing consults, ordering 1:1, etc). You don't have to be a rockstar, you don't even need to be solid, but you should be able to be helpful to the team and be putting in an effort to learn the basics.
Remember, you're a physician first, and the first step of evaluating any psych patient is ruling out a medical cause for their condition. It would be pretty hard to do this if you're so bad you can't even handle the most basic medical problems. Additionally, you should be able to manage the basic side effects our medications cause. If you're going to put someone on Olanzapine and they get metabolic syndrome, you should be able to at least start them on metformin until they can see their PCP.
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