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though he is not really wrong...
Terminated from IM residency (PGY-2)
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The only way the appeals committee will go your way is if your program has failed from a process/policy perspective. Read the remediation policy now. Make a detailed and supported argument for how policy wasn't followed. You aren't going to convince them on reevaluation of the substance of the complaint.
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Wow! To be honest with you apparently your attitude might have not been the best. First of all, if your PD tell you, you need to change this or that, you just do it, by you telling him you have mental issues and anxiety sounds more like an excuse not to do what they are telling you. It's very sad but true than even in our own fields mental diseases are still getting overlooked like that, because, depression could have been one big cause why you forget stuff.
And then also your peers don't have this issue. you forget to put in orders or patients complaints against you (possible lawsuit if you actually miss or forget something major), you still try to argument that you have "issues". Instead of Idk, maybe writing things down, doing a checklist, asking your peers how they do, not to miss anything... I suppose at the end your attitude wasn't well perceived by the program. they might just thought you were given excuses not to do what you've told, and you are reluctant to take orders.
Anyways, try to match as soon as you can, get LORs, and Idk, try to polish your CV an try again. this time take some time to look into your behavior and responses to criticism, be strong don't let depression get to you. at the end they were trying to get you to be a better doctor. Soon enough you would be on your own and mistakes like that as an attending could cost you a lot of money and maybe your license. and they wont care if you were feeling anxious or depressed.
Be strong and best of luck
And then also your peers don't have this issue. you forget to put in orders or patients complaints against you (possible lawsuit if you actually miss or forget something major), you still try to argument that you have "issues". Instead of Idk, maybe writing things down, doing a checklist, asking your peers how they do, not to miss anything... I suppose at the end your attitude wasn't well perceived by the program. they might just thought you were given excuses not to do what you've told, and you are reluctant to take orders.
Anyways, try to match as soon as you can, get LORs, and Idk, try to polish your CV an try again. this time take some time to look into your behavior and responses to criticism, be strong don't let depression get to you. at the end they were trying to get you to be a better doctor. Soon enough you would be on your own and mistakes like that as an attending could cost you a lot of money and maybe your license. and they wont care if you were feeling anxious or depressed.
Be strong and best of luck
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The best way to avoid being under the microscope is to build-up as much good will as possible with your program director and attendings early on in the game.
People get fired for seemingly small infractions only after they've earned themselves a reputation for being someone who is unreliable and/or doesn't follow the rules. One thing my program director hates more than anything is people who try to get out of doing what they're supposed to do. E.g. seniors showing up late for checkout on ward months because no one complains about it.
One or two complaints by ancillary staff that a resident was rude to them is not going to get anyone in trouble if you're PD is even remotely reasonable. Problem is, all it takes is one time to set the snowball rolling. You piss off one nurse, he/she can set the entire army against you and put you under their microscope. Now they'll start to complain about everything you do, no matter how reasonable. Best to just always be nice to everyone no matter how annoyed you are.
We have a few RTs at our hospital who are complete idiots, but I was taught to accept their advice anytime it is offered. Just smile and say, "Oh wow thanks for your advice." Then when they leave, just do whatever you were going to do. No one is giving out prizes for winning arguments with idiot VA nurses/RTs/etc. In fact, that statement holds true even for coworkers and attendings. Getting a point over on some attending/upper-level has never made someone's job more secure, but it's certainly lost a few.
Lastly the worst reputation you can get in residency isn't for incompetence, it's laziness. You can be borderline clinically retarded and still keep your job if you work hard and show-up on time. In contrast, you can be the most genius resident in the world, but if you are lazy, do the bare minimum, and show-up late, you are going to be fired. If your peers start to see you as a lazy colleague, you are going to be under their microscope. People will forgive the dumbass for being 10 minutes late that one time, because he doesn't make a habit of it. The genius will never be given any latitude once he's proven himself to be unreliable. No one who works 80 hours per week wants to pick up the slack for you, and it won't take many complaints from your coworkers to get you in trouble.
People get fired for seemingly small infractions only after they've earned themselves a reputation for being someone who is unreliable and/or doesn't follow the rules. One thing my program director hates more than anything is people who try to get out of doing what they're supposed to do. E.g. seniors showing up late for checkout on ward months because no one complains about it.
One or two complaints by ancillary staff that a resident was rude to them is not going to get anyone in trouble if you're PD is even remotely reasonable. Problem is, all it takes is one time to set the snowball rolling. You piss off one nurse, he/she can set the entire army against you and put you under their microscope. Now they'll start to complain about everything you do, no matter how reasonable. Best to just always be nice to everyone no matter how annoyed you are.
We have a few RTs at our hospital who are complete idiots, but I was taught to accept their advice anytime it is offered. Just smile and say, "Oh wow thanks for your advice." Then when they leave, just do whatever you were going to do. No one is giving out prizes for winning arguments with idiot VA nurses/RTs/etc. In fact, that statement holds true even for coworkers and attendings. Getting a point over on some attending/upper-level has never made someone's job more secure, but it's certainly lost a few.
Lastly the worst reputation you can get in residency isn't for incompetence, it's laziness. You can be borderline clinically retarded and still keep your job if you work hard and show-up on time. In contrast, you can be the most genius resident in the world, but if you are lazy, do the bare minimum, and show-up late, you are going to be fired. If your peers start to see you as a lazy colleague, you are going to be under their microscope. People will forgive the dumbass for being 10 minutes late that one time, because he doesn't make a habit of it. The genius will never be given any latitude once he's proven himself to be unreliable. No one who works 80 hours per week wants to pick up the slack for you, and it won't take many complaints from your coworkers to get you in trouble.
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Só an asymptomatic patient was after a “full physical examination” (whatever that means) and went on to complain about you because you didnt auscultaste his chest? I am not from the US but that sounds unusual even for crazy patients. I think either your problems might run somewhat deeper than you make it out to be or you have been very unlucky.
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Fair enough, sorry.
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As mentioned above, usually the appeal committee looks at whether the process was fair, not whether the assessment was correct.
The appeal committee is often made up of PD's and other educators from other fields. If I'm on the appeal committee for a surgical resident who is being terminated for being a klutz in the OR, I'm not going to review evaluations and second guess the surgical PD's assessment. I'm going to assess whether the resident was given a summary of their deficiencies, an opportunity to improve, and a fair assessment of whether the problems had been resolved.
what if a PD presents facts in a way that is not exactly the truth. And what if you can find proof in medical records. They will not make a consideration?
If you start going into medical records on your own, for the purpose of finding "proof" to refute your PD's claims, then I can guarantee you that you're going to have a bad time. That would be a HIPAA violation and that alone would be enough to fire you. Please don't do that. And I'd advise consulting a lawyer first to find out what your options are if you're thinking this is the end of the road.
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A lot of this appeal talk is crazy - you should NOT view the appeal process as an opportunity to prove yourself right or demonstrate unfairness in the process. I'm not going to relitigate what others have said here, but in general agree that your insight into performance is probably not great. Losing a resident mid year is a disaster for a program, and they don't take it lightly. Also, the standard evaluation is "positive." Most people just give you kudos and move on because it's easier than telling you what you did wrong, then they complain behind your back to the chiefs or PD.
None of that matters now. You need to focus on getting back into residency. Finding another spot is going to be a nightmare AND if you're going to find another spot, you'll need support from your program. That means you should view this appeal process in two ways:
1. Your last opportunity to get a second chance. Be gracious, admit mistakes, don't lose your cool, be thankful for the chances you've already been given, offer them a PLAN for how you intend to change. Denying their perception of you isn't going to fix anything - regardless of the true situation, they clearly think you have deficiencies. Most educators love a turnaround and want to believe they can jnspire - just give the the chance to see you as that. Say you have learned from this and you're going to come out better. Accept their criticism and show them you can take it with grace.
2. If they kick you out anyway, this appeal is your LAST chance to grease the wheels for your job search. You can bet PDs at other programs are going to call your PD to ask WTF happened. If you spent the appeal acting like a martyr, denying problems that seemed patently obvious to others, or acting like you were unfairly treated - what do you think your PD will tell them? They'll be careful and won't put it in writing, but they'll torpedo you and nobody will hire you. On the other hand, if you do what I say above and try to recoup some respect / appeal to their better side, it may be enough to get your PD out of the way. Him or her saying "He has no insight into his problems and is unprofessional" is a death sentence. Saying "you know, we had some differences but in the end he carried himself well and I think he could do well elsewhere" may be enough to get you a look and a fresh start.
Long story short - you def screwed up here. How much is fair and how much was a witch hunt is irrelevant now, though. Your best way forward isn't legal - it's accepting responsibility, holding your composure, and appealing to their better graces.
None of that matters now. You need to focus on getting back into residency. Finding another spot is going to be a nightmare AND if you're going to find another spot, you'll need support from your program. That means you should view this appeal process in two ways:
1. Your last opportunity to get a second chance. Be gracious, admit mistakes, don't lose your cool, be thankful for the chances you've already been given, offer them a PLAN for how you intend to change. Denying their perception of you isn't going to fix anything - regardless of the true situation, they clearly think you have deficiencies. Most educators love a turnaround and want to believe they can jnspire - just give the the chance to see you as that. Say you have learned from this and you're going to come out better. Accept their criticism and show them you can take it with grace.
2. If they kick you out anyway, this appeal is your LAST chance to grease the wheels for your job search. You can bet PDs at other programs are going to call your PD to ask WTF happened. If you spent the appeal acting like a martyr, denying problems that seemed patently obvious to others, or acting like you were unfairly treated - what do you think your PD will tell them? They'll be careful and won't put it in writing, but they'll torpedo you and nobody will hire you. On the other hand, if you do what I say above and try to recoup some respect / appeal to their better side, it may be enough to get your PD out of the way. Him or her saying "He has no insight into his problems and is unprofessional" is a death sentence. Saying "you know, we had some differences but in the end he carried himself well and I think he could do well elsewhere" may be enough to get you a look and a fresh start.
Long story short - you def screwed up here. How much is fair and how much was a witch hunt is irrelevant now, though. Your best way forward isn't legal - it's accepting responsibility, holding your composure, and appealing to their better graces.
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Excellent insight - the best outcome is a positive LOR, worst being a negative one. If pursing involement with a lawyer - expect delays, increased costs and neutral LOR (which other PDs would be able to pickup on)
Approach PD with hat in hand, clear eyes and open heart...
Should I email him or write a post mail-delivered letter. Or use the appeal process to start the apologies. TO bee honest I have already written an apology letter and he seemed opened to it. He had been extremely supportive and extremely forgiving until a life event led me to become attitudy, confrontational at times I must admit and things spiraled out of control over a period of 2 weeks by his own admission. Even at dismissal meeting, he said "this could be a blessing in disguise, I hope this helps for your future". Granted, I was heartbroken and he was trying to comfort me after essentially firing me. He was my mentor and my adviser. We had a great rapport till I rub the wrong person the wrong way and he was set up to straightnen things out but I reacted the wrong way, defensive. A simple sorry, I won't mess up again would have saved my neck. But I was in my own serious personal issue and lost insight. I do not think I can or will be forgiven. Plus there is a serious ongoing bully situation with my co-fellow I don't want to relive. The smartass and very efficient fellow was remediated trough HR for " obscenities", behaved for a few weeks, but quickly regained his old ways; this made me resentful that he was bullying me with their blessing and nothing was done. I became isolated. I seriously messed up and I need serious advice here. Should I send separate apologies to the attending I think I most likely offended-was not the PD but she inflamed him against me and I am all but screwed up-. I wishI had found this place before, I would have gotten insight into "the situation" and would have quickly made amends. Now I am sad, depressed, sleepless and desperate.
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Sorry, but what the heck is going on here? Who are you and what does this have to do with the OP' situation?
Situation is similar was looking for answers. Sorry if I infringed any rules here.
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you didn't...its not like this is the OP's personal thread.
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she "obviously" has the same issue as the OP...was dismissed and wants to see what she can so about it...who the heck are you noob to be admonishing her for seeking advice?
My point was that she started her story in the middle of her own story. If you feel the need to give her advice, then stop wasting your time replying to some "noob and go ahead and give her advice. Next..
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right, like advice from a med student is going to help her anyway...
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Then state that up front.
2 brand new users with all their posts in the same thread is confusing at a minimum, and looks a lot like sock-puppeting.
Hey guys. Unfortunately the second reviewer upheld the decision. He didn’t have anything to say as to why he thought I should have been dismissed. He just kept repeating “I’ve reviewed all that information and think the proper policies were followed for this process” like a broken record till he said we were out of time at which point I smiled and left.
Thank you all for your help.
Thank you all for your help.
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I'm sorry, man. I hope things work out for you. I really do. All the best!
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I’m sorry to hear that. Hope you find a position elsewhere.
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This thread started in October, I'm amazed it took this long to resolve, but I'm sorry that it worked out that way for you.
Unfortunately, one more piece of bad news: Something I mentioned earlier in this thread is incorrect. If you're on a J visa and you're terminated, you don't get the 30 day grace period. You need to vacate the US immediately, else risk being found out of status which could jeopardize future visa applications. You only get the grace period if you complete a program. Bummer.
Unfortunately, one more piece of bad news: Something I mentioned earlier in this thread is incorrect. If you're on a J visa and you're terminated, you don't get the 30 day grace period. You need to vacate the US immediately, else risk being found out of status which could jeopardize future visa applications. You only get the grace period if you complete a program. Bummer.
My program said they’re going to keep me on the payroll till March 31st and ECFMG will decide my visa status thence forward. However, I plan to leave before that date.
My biggest disappointment was the fact that I was mistaken to believe that critical thinking and a logical approach were welcome here. They just need mindless drones who don’t ask questions, just do what they’re told and keep their mouths shut while nodding their heads.
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From reading the thread it sounds like your own insight into your issues in residency was also poor. It doesn’t sound like you’ve learned a lot from this.
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Maybe that mattered when we were trying to save him from being fired but not anymore
My insight seems to be poor because I kept begging my attendings for feedback and they kept saying I was perfect/ near perfect. All I wanted was a logical argument for my dismissal and nobody in my program was able to provide that to me.
Moreover, the shock and awe in those attendings and the common thought that this was unfair didn’t help either. The argument that “If there’s smoke, there is a fire” is not good enough to fire somebody.
Furthermore, the attendings that did have something to say said I need to be more a reporter than an interpreter which is another way of saying “bend the knee”.
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I’ve been on the other side as a program evaluates the merits of keeping or dismissing a resident who has had issues. One thing I can confidently say is that once you’re under the microscope problems are “found” to reinforce the initial concern, even if there are other residents who are guilty of the same thing. What this causes is more and more scrutiny and depending on the resident their personality etc this can cause major issues in and of itself. I agree it sounds like there is a bit of lack of insight as nearly all of the problem residents I’ve encountered either knew there was an issue or once explained, even if they didn’t agree understood the situation. Anyway, sorry you’re in this predicament I wish you the best of luck
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So you think you were fired because.... what? You didn't "bend the knee"?
I was fired because my program wanted to get rid of me. They were just tired of hearing stuff about me. They lost objectivity and kept waiting till I made enough mistakes for a defendable dismissal.
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Why, do you think, were they hearing so much stuff about you in particular that they lost objectivity and wanted to dismiss a resident?
Since it had been about a year that I was on probation, it was common knowledge. Chiefs used to individually ask attendings and interns about my performance outside rounds. Although they said my performance was really good, they would mention minor events that otherwise are normally ignored. I’ll give you an example. Once we were just done with rounds and one of my interns said she needed to complete her notes before heading to a mandatory conference. I knew that she would not come because she had that many patients. Hence I left because I did not want to be late. The attending found out and mentioned to the questioner that week that I once left for conference before my intern was finished with her duties for the day.
This is a classic case of the “damned if you do, damned if you don’t” situations that I had been in. I just could not do anything right in their eyes.
P.S. That intern never attended that conference and no one cared.
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And you were on probation because.....
Because I had some friction during a rotation with the associate program director who wrote me an extremely vile and toxic evaluation, failing me in all competencies (even medical knowledge which was positively highlighted by almost everyone before and after her). Other than that, my evaluations were always average to exceptional with most on the exceptional side.
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Why do you think your PD did that?
MS4 here for what its worth but here's an outside perspective.
Sounds like you sunk your intern and skirted your work. It is easy for it to look like she COULDN'T attend the conference because her resident abandoned her to do patient care without help or guidance. I've definitely seen PGY3s take a stack of notes off of an intern (divide work) on occasion so they could both attend something mandatory and educational.
I don’t know. I kept asking them and the best they could answer was “I want to trust you but I’m just having a lot of trouble trusting you”.
Thanks for your input but I had already made sure ALL the orders from rounds were carried out. She was an extremely slow typist and said she needed time to type all the notes. I didn’t think that was something I could help her a lot with. Furthermore, I was afraid of being late as our chiefs kept tabs of who came when. If I had been caught late or missing, there was no excuse that could have satisfied my PD.
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Soooo what’s your plan now?
There are multiple attendings who called me and offered to write LORs. I hope I find a program that considers to take me as a PGY 2 before the next academic year.
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Did you think to ask your senior which course of action they preferred?
“Hey, we’re running behind on notes but I have all the orders in.....i’d like to not leave “so and so” hanging so is it ok if I stay and help her finish the notes or do we both need to go to the conference “
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So try and scramble in to a program outside of the match?
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Start mass emailing program directors now with an honest email. I consider this to be a hail Mary for you though since it sounds like you won't be getting a positive endorsement from your current pd. That combined with you being fired mid year will make only the most desperate programs interested.
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You are supposed to bend the knee. You were practicing under their license. Ultimately, you have to do what you are told. You don't get to argue endlessly.
It doesn't matter where you go. It is the same everywhere. It is probably worse in developing countries.
When you go back, make sure you don't forget about this.
I still wish you the best.
Thinking back that does seem a more reasonable option but I was so engulfed by the fear of being dismissed that I didn’t always think about such decisions that deeply and made impulsive decisions often.
I don’t have a problem with shutting up if I’m convinced logically by my superiors. That’s the reason I got the best evaluations from the senior most faculty. I’m copy pasting the evaluation from our chief of medicine so you might get an idea.
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