Terminating residents

[AdmiralChz]

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Does bad ite means you have to repeat a year??

Absolutely yes, especially if there are other concerns that you aren't meeting criteria for advancement. Go back and read your residency handbook.

Also, why did you dig up this old and very lengthy thread?

 

[ThoracicGuy]

Almost in same position, getting harassment from stupid hospitalist with out having any objective data on my incompetency

 

[deuist]

Does bad ite means you have to repeat a year??

I've never seen a resident repeater the entire year for a low ITE, but I have seen residents placed on probation as well as residents asked to take a year off for research.

 

[Siggy]

I've never seen a resident repeater the entire year for a low ITE, but I have seen residents placed on probation as well as residents asked to take a year off for research.

What are they researching? Harrisons and MKSAP?

 

[GMEComplianceProject]

Lots of good insights throughout the thread. Despite this topic recurring over many years, little has changed in what we understand of the inner workings of our programs. Much of what takes place in some residency Core Curriculum Committees which decide residents' fates may be in violation of ACGME requirements for objective evaluative processes. What do you do when you believe that you have been treated unfairly, that subjective information or hearsay has been used to your detriment, that you may have been targeted because of personal differences or whistleblowing,...?

 

[amiroom]

Hello All
First of all I am not a resident, my gf is PGY3 surgery resident so I am trying to help her since she is really freaking out.
she did very bad in her 2 last ABSITE scores( below 10% percentile) so the program director is opening the option of termination but she proposed to go on research fellowship for one year and meanwhile study and do the test again on Feb.
Question is, is there a guarantee that her position is secured after a year? what can guarantee that.
Thanks for your help in advance.

 

[ThoracicGuy]

Hello All
First of all I am not a resident, my gf is PGY3 surgery resident so I am trying to help her since she is really freaking out.
she did very bad in her 2 last ABSITE scores( below 10% percentile) so the program director is opening the option of termination but she proposed to go on research fellowship for one year and meanwhile study and do the test again on Feb.
Question is, is there a guarantee that her position is secured after a year? what can guarantee that.
Thanks for your help in advance.

The ABS states that the ABSITE is not to be used for promotion criteria. That said, the program could always find other reasons to fire someone/nonrenewal if they wished.

She needs to reassess her study techniques and find something better that works because whatever she did the past two years isn't doing it.

 

[guitar45]

That is really strange that senior members out here have not known many residents who have been terminated.

I know alot of them. And all from one program in family medicine. Over the last 5 years the program has terminated 8 residents. Now the program has itself been terminated from the hospital and not accepting any more residents. The terminated residents have tried to get into other programs, but the PD has refused to give them papers without wanting to intervene. And hence, they were not able to be accepted anywhere else.

There was complaints to the ACGME, but the PD had good documentation that the ACGME could not tamper with accreditation.

Now two of the attendings have resigned because of internal problems; but all the residents believe that the attendings resigned because of bad treatment of residents. We all know that attendings are divided into - Resident friendly attendings and Not Resident friendly. The two who resigned were the only two resident friendly attendings in the program.

Only one of the residents terminated had a drug problem. The others just got on the bad side of their attending and were hunted down and chased out.

Each of them was told that "Every year a resident is picked as a Scape Goat" And that they were the scape goat for that period. And every scape goat was eventually terminated. What does that say about a residency in Family medicine.

Is there any help out there for residents who have faced bad luck like this.

Guess the bullying just will not end....Too bad medical field still insists on tactics that are deemed inappropriate virtually anywhere else but the military or prisons.

 

[VA Hopeful Dr]

Guess the bullying just will not end....Too bad medical field still insists on tactics that are deemed inappropriate virtually anywhere else but the military or prisons.

Yes because every program is that malignant

 

[amiroom]

The ABS states that the ABSITE is not to be used for promotion criteria. That said, the program could always find other reasons to fire someone/nonrenewal if they wished.

She needs to reassess her study techniques and find something better that works because whatever she did the past two years isn't doing it.

Thanks
Do you think her spot would be guaranteed if she leaves for a year of research/studying?

 

[ThoracicGuy]

Thanks
Do you think her spot would be guaranteed if she leaves for a year of research/studying?

Nope. Nothing is guaranteed. If they want her gone, they'll find a way that passes legal muster.

Best she can do is appeal to them to keep her. If she's fired, she would rely on them to put a word in to other programs, surgery or otherwise.

 

[NotAProgDirector]

If the main reason she is being fired is ABSITE performance, then a year of research would allow her to study for and hopefully improve. The ABSITE exam appears to be given at the end of January / beginning of Feb, so she would have 6-7 months to prepare while doing research. If they want to terminate her for ABSITE + other performance issues, the research year will not help at all with other issues.

And nothing is guaranteed. Even if she improves, they might let her go. Without doing it, her chances of being let go seem very high.

And then her performance needs to be maintained or improved in future years, or the same problem arises.

 

[Crayola227]

When it looks like you are on the path of no return, consider bringing up a "voluntary" resignation. Sometimes programs will prefer this to a termination, for various reasons. It makes the process easier for them, and in return you might be able to ask for a negotiated letter of recommendation. Food for thought. Just the fact that you choose to go without fuss can make them more inclined not to bad mouth you later.

I know people who have resigned without a formal agreement or negotiated LOR, and got totally boned by their program. Part of this was performance, the other part was bitterness on the part of the program. Or, perhaps, because there wasn't a legal agreement signing forms that were needed by the ex-resident weren't high priority and fell through the cracks.

 

[guitar45]

Yes because every program is that malignant

Didn't mean to imply that...sorry you read it that way.

 

[guitar45]

Yes because every program is that malignant

And to GORO and those who felt this was too harsh, especially Goro, ARE THERE ENOUGH RESIDENCY programs, for programs like IM or FM? Or are medical students being fooled out of spending $250,000 or more, with certain programs offering little or NO SUPPORT for M4 students to help with the Match (there are certainly some - not saying Goro's program is one; have no idea). I realize students have to monitor their own progress & ask forhelp, etc. But some programs recognize that, esp since a lot of $$ is made in 3rd & 4th years, they could at least offer some support to give back for the $$ they are getting. I can see why PA or NP programs seem much more enticing

 

[VA Hopeful Dr]

Didn't mean to imply that...sorry you read it that way.

You took a single bad program and generalized it to medicine as a whole. If you didn't meant to imply that, then I would strongly suggest working on your rhetorical skills.

 

[VA Hopeful Dr]

And to GORO and those who felt this was too harsh, especially Goro, ARE THERE ENOUGH RESIDENCY programs, for programs like IM or FM? Or are medical students being fooled out of spending $250,000 or more, with certain programs offering little or NO SUPPORT for M4 students to help with the Match (there are certainly some - not saying Goro's program is one; have no idea). I realize students have to monitor their own progress & ask forhelp, etc. But some programs recognize that, esp since a lot of $$ is made in 3rd & 4th years, they could at least offer some support to give back for the $$ they are getting. I can see why PA or NP programs seem much more enticing

There are more residency spots than there are US MD/DO 4th year students. So yes, by that metric there are enough spots.

Could schools do more to help their students? I mean, maybe? I'm not sure what kind of help you're getting at though. Genuinely curious what you have in mind.

 

[Arcan57]

And to GORO and those who felt this was too harsh, especially Goro, ARE THERE ENOUGH RESIDENCY programs, for programs like IM or FM? Or are medical students being fooled out of spending $250,000 or more, with certain programs offering little or NO SUPPORT for M4 students to help with the Match (there are certainly some - not saying Goro's program is one; have no idea). I realize students have to monitor their own progress & ask forhelp, etc. But some programs recognize that, esp since a lot of $$ is made in 3rd & 4th years, they could at least offer some support to give back for the $$ they are getting. I can see why PA or NP programs seem much more enticing

Are you talking US or IMG schools?

 

[FlowRate]

If anyone is interested, the linked post at the end has written testimony from a PD and independent reviewer/outside PD on a residency termination case. It really takes a lot to fire a resident. Resident Termination

 

[Crayola227]

I have read both documents, and I am in no way impressed with "how difficult" it is to fire a resident. It's practically cookbook to do so.

It only gets hard if an attorney becomes involved for anything beyond negotiating a "voluntary" resignation.

I imagine where things could get dicey is if the PD doesn't have the department chair and GME on their side for some reason, and the resident appeal isn't actually in front of a kangaroo court.

Keep in mind that I am not excusing this particular resident in any way or taking their side.

There are clearly statements of conduct that is never acceptable and there is no excuse for.

This dismissal was difficult because an attorney got involved and much as we might not like it, after reading the resident's conduct, there was clearly still a case in the court of law, at least.

Much as this case should not be used as the standard of "look at the big bad meanie malignant program," neither should it be used to show how difficult/easy it is to terminate or force residents to resign in many cases.

I think we forget also, and it is definitely easier for a program, and by its very terms would never reach court or the public eye, are forced "voluntary" resignations. There's many reasons both sides frequently seek this resolution. Some of those are just terminations in disguise, the resident just wanted to avoid the scarlet letter T and went for R instead.

Or just cases of non-renewal.

 

[WingedOx]

I mean, the process involved in all this for Dr. C. alone in these documents must have taken hours upon hours. A program needs to have all of its ducks in a row to preemptively be prepared for the lawyers to get involved long before they do. I'm going to assume that it's not that uncommon for some seriously deficient residents to continue to be advanced due to the onerous burden of making the case for termination.

 

[Crayola227]

I mean, the process involved in all this for Dr. C. alone in these documents must have taken hours upon hours. A program needs to have all of its ducks in a row to preemptively be prepared for the lawyers to get involved long before they do. I'm going to assume that it's not that uncommon for some seriously deficient residents to continue to be advanced due to the onerous burden of making the case for termination.

The only thing here that confuses me is why they would advance when they can just not renew. Not sure how much leverage a resident has in that case since it's at will employment. People can sue at any time for anything, but I would think a case would be weakest at that point, so the least onerous for a program I would expect then.

I find it pretty disturbing that the program would advance a resident rather than just not renew.

Possibly I don't understand hoe that works though.

 

[operaman]

From a legal perspective, there is no difference between non-renewal and immediate termination. Both are effectively the same thing and susceptible to the same sort of legal action. Furthermore, the same internal due process required for dismissal (warnings, probation, etc.) also applies to contract non-renewal. From an administrative standpoint, there is similar burden. In some ways, immediate termination is easier because it usually follows an egregious offense and circumvents the whole process.

Despite what's often said here, I think most programs and PDs genuinely care about their trainees and want to train safe, competent physicians. Nearly every resident comes in with some weaknesses and most are able to address them in the due course of the training program. Others require some additional work and are able to successfully complete some form of remediation and go on to do well. I think everyone is conscious of the time invested in someone getting to residency and also well aware of the detrimental effects of termination. The faculty I've spoken to who have been through a termination process describe the great personal toll it takes on them and how long they wrestle with the decision and genuinely want to try anything that will allow the resident to succeed. I think we can see that mindset in the court documents where faculty bend over backward to help but are eventually faced with the realization that they can't allow that person to continue their training.

 

[Goro]

And to GORO and those who felt this was too harsh, especially Goro, ARE THERE ENOUGH RESIDENCY programs, for programs like IM or FM? Or are medical students being fooled out of spending $250,000 or more, with certain programs offering little or NO SUPPORT for M4 students to help with the Match (there are certainly some - not saying Goro's program is one; have no idea). I realize students have to monitor their own progress & ask forhelp, etc.

Can you elaborate?

 

[GMEComplianceProject]

Hello All
First of all I am not a resident, my gf is PGY3 surgery resident so I am trying to help her since she is really freaking out.
she did very bad in her 2 last ABSITE scores( below 10% percentile) so the program director is opening the option of termination but she proposed to go on research fellowship for one year and meanwhile study and do the test again on Feb.
Question is, is there a guarantee that her position is secured after a year? what can guarantee that.
Thanks for your help in advance.

If her ABSITE score is being used as the primary criterion for her termination or remediation, she should have had an "academic probation" period. Has she talked to the Graduate Medical Education DIO and the resident ombudsman? Probation requires certain elements: a time frame, a remediation plan, a mentor, routine follow up, actual help,... If the program is not following ACGME and local GME policies, she should have standing for an appeal through the GME/Dean's office. In practice, as has been said elsewhere in this thread, if the PD wants to can her, he/she likely can. And the more the resident tries to defend herself, the more the tide of opinion can turn on her as a "problem resident." Look me up and we can talk offline. I'm supporting someone through a very similar issue.