Terminating residents

[wispers2u2]

Yes, I was terminated and would like to start a support group

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[wispers2u2]

I think that the argument you are making is in-congruent with the reality of the residency training we are talking about. The problem we are talking about is not residents who are incompetent or lazy but residents who are unfairly targeted based on the overly political scene that doctors have turned residency into. Most evaluations are not used by attendings to give accurate feedback but to abuse and discriminate against residents if they don't like them. The only residents that have the option of being lazy and incompetent are the protected ones that nobody touches. I have seen it countless times. As long as you are liked, you could commit murder and nobody says a thing about it. If you are not liked, that's when you are evaluated to be incompetent when you are and so on and so forth.

 

[NotAProgDirector]

I'm going to respond to the two posters who report being terminated. First, I want to be clear that my purpose is not to "kick you when you're down", but hopefully either you or someone else reading this will be helped.

First of all, no resident is lazy or incompetent. If you have the drive and initiative to get into med school, get through med school, and get into residency -- you already put in so much effort, time, and money into the whole process that you are clearly motivated, was cleared on the competence issue by med school/exams, etc.

I completely disagree, for several reasons. First is the definition of "incompetent". I am incompetent at flying a fighter jet. I have no idea how to do so, and if someone put me in the pilot's seat and told me to fly it, it wouldn't end well. So, yes, a resident can be incompetent -- it simply means that they do not have the skills to do the job assigned. Could I become competent at flying a fighter jet? I'd like to think that I could, presumably with enough training and practice I'd be able to do so. So, residents can be incompetent for the job that they were hired into. Perhaps, with more training, they could become competent at that job, but it's not a program's job to do so.

Also, residents can definitely be lazy. The skills and time commitment needed to succeed at residency are different than those in medical school. I have definitely seen residents who were unwilling to put the effort needed into their education.

Second of all, I would like to share my sad story of woe. First residency I matched into was General Surgery. Full of piss and vinegar, ready to do whoever and whatever -- I lasted only a month in it and had to quit b/c of it being too overwhelming and just not being able to handle it. Discussed the difficulty before quitting with PD and Graduate Studies Director, but was given no guidance or help.

I hate to say it, but you were incompetent to be a surgical resident in this program at this time. That doesn't mean that you couldn't improve and become competent. Your PD doesn't necessarily need to give you guidance or help -- it sounds like you were seriously in over your head and help wasn't going to address the situation. Your PD is under no requirement to help you get your next position, either.

Miraculously matched into a less intense residency of Family Medicine -- anything just to keep the career. Was dimissed from that residency in three months after I missed a day of work due to hospitalization. Was honest and stupid enough to tell the PD that I was hospitalized for phsychiatric reasons (resolved once I cought up on my sleep). Was not allowed to come back, was told to seek therapy, then to call back and see.

This situation is more complicated. In general, it's illegal for them to fire you just because you're ill. You would have had a contract, and unless the contract specifically states that you get fired if you miss a day because you're ill, you are relatively protected.

However, the devil is in the details. Did you call to tell them you were going to be absent, or just not show up? If you didn't call, then you would need to prove that you were too ill to call. Otherwise, that's a serious problem.

If you did have psychiatric problems, that's also complicated. Your PD can insist on a "fitness for duty" evaluation -- a separate physician evaluates your health and determines whether you can, or cannot, function in your job. The problem with many psychiatric problems is a lack of self awareness of your limitations. Patient safety is paramount, so someone needs to assess whether you are safe to care for patients.

a) how could I afford therapy if you just fired me and I have to move in back with my parents/parent?

An interesting point, but "not my problem" as your PD. I can't fix the world's problems. I agree that it might be more humane to put you out on medical leave -- either via FMLA (where you would need to cover your health care insurance costs, and get no salary) or medical disability (where you likely get paid your salary, and have your benefits continue). The "problem" from my standpoint is that in both cases, I can't hire someone new. There's no such thing as a "temp intern". So, if I keep you on, I then have to rejigger the whole schedule, making eveyone else cover your work, in the hope that you will get better and come back. It's an interesting ethical dilemma -- doing what's "best" for you might hurt everyone else in the program, vs hiring someone new hurts you but is the fairest option for everyone else.

b) i missed a day of work due to hospitalization -- b/c of HIPAA it is none of your business why I was hospitalized, for all you know, I had gastroenteritis and had to spend a day at the ER.

Totally agree. You didn't have to tell anyone why you were hospitalized. You did have a duty to inform your workplace that you were absent, and they can require some sort of documentation for your absence (a simple note would suffice). They can also require a fitness for duty evaluation upon your return.

c) if you really want to help me and have me be part of your residency, why don't you keep me as a resident and arrange me to have one half-day off/wk to go see your in-house or private physician, thus making sure I get the help you require of me (and I supposedly need), but at the same time not leaving me without a means to support myself.

Arranging this in a resident's schedule is not easy. Who exactly is going to do your work on those afternoons? Is this fair to your co-workers? Is your performance the rest of the time truly satisfactory? Is 1/2 day per week really sufficient to address your problems?

d) The program director left the residency six months after I got fired/dismissed. So in 12 months, when I was ready to work and called back to see if they would take me back -- there was a new program director and no one knew who I was and what I was talking about.

This is unfortunate, but you should have been in communication with your program regularly (i.e. every month) and this would have been less of an issue.

e) All my issues were cured by getting enough sleep, not meds, not therapy, just good old restorative, REM sleep and rest.

If the shifts of your residency were the problem with your sleep, then I don't see how that could have been addressed adequately. If you simply stayed up late on your own, then that was a poor choice. I guess my point is that I think your termination was likely due to more than simply getting admitted -- likely your performance was less than satisfactory, and then your admission becomes the final straw.

On the other hand, psychiatric illness clearly has a negative connotation here in the US. Once you get admitted for your psych issues, that elevates your problem to a new level. You'd need to be frankly suicidal or psychotic to get admitted, and both of those issues would raise serious concerns in any training program.

f) I find it impossible to get a job anywhere except places that pay minimum wage. And I have med shcool debt. My career which was the basket into which I put in all my eggs has been destroyed. The loss one experience when being dismissed from such a prestigious position as a resident/physician is devastating and beyond anything I can say in words to describe the feeling.

This is a real problem. You were terminated by two programs. Not many programs are going to want to take a risk on you again. I hope you can see that taking you into a program is risky. You need to do something to mitigate that risk.

g) I find it impossible to get new letter of recommendation from anywhere to apply again.

Not surprising, since you were in both programs for less than 6 months. What do you expect people to say? Your performance may have been sub par to begin, deteriorated as you became more psychiatrically ill, culminating in your admission. Even if your performance was totally fine the entire time, the best that someone could write would be just that, and that won't get you far.

h) finally, I was dimissed for phsychiatric issues, but I had none or did have them but they were under control. however, after it sank in and I realized that there was no way for me to ever become a physician and that I would have start over -- that's when psychiatric issues of grief and loss and all that that entails surfaced.

What this says to me is that your psych issues were just below the surface. All of the stress of residency was likely to make them manifest (and likely did). I doubt your psych issues were under good control when you were terminated. I wasn't there, so I certainly can't say. But I also know that you can't really say either, since these things are impossible to self assess.

I think that the argument you are making is in-congruent with the reality of the residency training we are talking about. The problem we are talking about is not residents who are incompetent or lazy but residents who are unfairly targeted based on the overly political scene that doctors have turned residency into. Most evaluations are not used by attendings to give accurate feedback but to abuse and discriminate against residents if they don't like them. The only residents that have the option of being lazy and incompetent are the protected ones that nobody touches. I have seen it countless times. As long as you are liked, you could commit murder and nobody says a thing about it. If you are not liked, that's when you are evaluated to be incompetent when you are and so on and so forth.

This is a different issue. Yes, I am certain there are situations where residents are unfairly targeted. And, there is no question that there is some "magnifying glass" type effect -- once a resident is "in trouble", everything they do is examined with a magnifying glass and you find problems. Those same problems might be present in other, but go unnoticed. So the pressure mounts, the resident's performance degrades, and termination ensues.

However, it is often difficult for a resident with real problems to have the insight to see them. It's "easy" to blame the system for your own failings. Residents often claim that "everyone does it" or that their behavior is not outside the norm.

This is what makes evaluation of residents so difficult. There are no objective tests of competence, and there won't be any. It will always be a subjective evaluation, and subjective evaluations are subject to bias.

 

[DOk1ng]

I'm going to respond to the two posters who report being terminated. First, I want to be clear that my purpose is not to "kick you when you're down", but hopefully either you or someone else reading this will be helped.



I completely disagree, for several reasons. First is the definition of "incompetent". I am incompetent at flying a fighter jet. I have no idea how to do so, and if someone put me in the pilot's seat and told me to fly it, it wouldn't end well. So, yes, a resident can be incompetent -- it simply means that they do not have the skills to do the job assigned. Could I become competent at flying a fighter jet? I'd like to think that I could, presumably with enough training and practice I'd be able to do so. So, residents can be incompetent for the job that they were hired into. Perhaps, with more training, they could become competent at that job, but it's not a program's job to do so.

Also, residents can definitely be lazy. The skills and time commitment needed to succeed at residency are different than those in medical school. I have definitely seen residents who were unwilling to put the effort needed into their education.



I hate to say it, but you were incompetent to be a surgical resident in this program at this time. That doesn't mean that you couldn't improve and become competent. Your PD doesn't necessarily need to give you guidance or help -- it sounds like you were seriously in over your head and help wasn't going to address the situation. Your PD is under no requirement to help you get your next position, either.



This situation is more complicated. In general, it's illegal for them to fire you just because you're ill. You would have had a contract, and unless the contract specifically states that you get fired if you miss a day because you're ill, you are relatively protected.

However, the devil is in the details. Did you call to tell them you were going to be absent, or just not show up? If you didn't call, then you would need to prove that you were too ill to call. Otherwise, that's a serious problem.

If you did have psychiatric problems, that's also complicated. Your PD can insist on a "fitness for duty" evaluation -- a separate physician evaluates your health and determines whether you can, or cannot, function in your job. The problem with many psychiatric problems is a lack of self awareness of your limitations. Patient safety is paramount, so someone needs to assess whether you are safe to care for patients.



An interesting point, but "not my problem" as your PD. I can't fix the world's problems. I agree that it might be more humane to put you out on medical leave -- either via FMLA (where you would need to cover your health care insurance costs, and get no salary) or medical disability (where you likely get paid your salary, and have your benefits continue). The "problem" from my standpoint is that in both cases, I can't hire someone new. There's no such thing as a "temp intern". So, if I keep you on, I then have to rejigger the whole schedule, making eveyone else cover your work, in the hope that you will get better and come back. It's an interesting ethical dilemma -- doing what's "best" for you might hurt everyone else in the program, vs hiring someone new hurts you but is the fairest option for everyone else.



Totally agree. You didn't have to tell anyone why you were hospitalized. You did have a duty to inform your workplace that you were absent, and they can require some sort of documentation for your absence (a simple note would suffice). They can also require a fitness for duty evaluation upon your return.



Arranging this in a resident's schedule is not easy. Who exactly is going to do your work on those afternoons? Is this fair to your co-workers? Is your performance the rest of the time truly satisfactory? Is 1/2 day per week really sufficient to address your problems?



This is unfortunate, but you should have been in communication with your program regularly (i.e. every month) and this would have been less of an issue.



If the shifts of your residency were the problem with your sleep, then I don't see how that could have been addressed adequately. If you simply stayed up late on your own, then that was a poor choice. I guess my point is that I think your termination was likely due to more than simply getting admitted -- likely your performance was less than satisfactory, and then your admission becomes the final straw.

On the other hand, psychiatric illness clearly has a negative connotation here in the US. Once you get admitted for your psych issues, that elevates your problem to a new level. You'd need to be frankly suicidal or psychotic to get admitted, and both of those issues would raise serious concerns in any training program.



This is a real problem. You were terminated by two programs. Not many programs are going to want to take a risk on you again. I hope you can see that taking you into a program is risky. You need to do something to mitigate that risk.



Not surprising, since you were in both programs for less than 6 months. What do you expect people to say? Your performance may have been sub par to begin, deteriorated as you became more psychiatrically ill, culminating in your admission. Even if your performance was totally fine the entire time, the best that someone could write would be just that, and that won't get you far.



What this says to me is that your psych issues were just below the surface. All of the stress of residency was likely to make them manifest (and likely did). I doubt your psych issues were under good control when you were terminated. I wasn't there, so I certainly can't say. But I also know that you can't really say either, since these things are impossible to self assess.



This is a different issue. Yes, I am certain there are situations where residents are unfairly targeted. And, there is no question that there is some "magnifying glass" type effect -- once a resident is "in trouble", everything they do is examined with a magnifying glass and you find problems. Those same problems might be present in other, but go unnoticed. So the pressure mounts, the resident's performance degrades, and termination ensues.

However, it is often difficult for a resident with real problems to have the insight to see them. It's "easy" to blame the system for your own failings. Residents often claim that "everyone does it" or that their behavior is not outside the norm.

This is what makes evaluation of residents so difficult. There are no objective tests of competence, and there won't be any. It will always be a subjective evaluation, and subjective evaluations are subject to bias.

don't we go to residency program to become competent and skilled in our chosen field ?
then how come its not their job ?
Ofcourse, resident/intern have to read to maintain good MK.

 

[MD forever]

The Prog Director

All that core competencies thing being recognized by the ACGME is "Subjective" and Bias based contamination's can not be rule out. Oh that sound like true Health business. Dose that mean computer based evaluator are better than the "Scary Educators"?.

The funny part is that residency programs jobs is not to train, People they do not like, based on the mafia bias, controlling the residency program. Their job is to destroy the bad guys career based on protecting the public act "Super Hero". May be if the terminated resident get more training somewhere "Please GO and find a Program that will LIKE you and the your smelly shoes" they could become competent.

This make whole sense and better understanding why the health care business run this way, More insight from insider

The above comment in support for those had been "wrongfully terminated" Based on the Prog Director classification and not those who are not true physicians and need to be weeded out.

 

[QofQuimica]

don't we go to residency program to become competent and skilled in our chosen field ?
then how come its not their job ?
Ofcourse, resident/intern have to read to maintain good MK.

Yes, I found that statement curious as well. What, exactly, is a new intern supposed to be competent at doing? Having been a new intern not all that long ago, I feel fairly confident in saying that new interns are complete idiots for the most part when it comes to the practice of medicine. You're barely even competent to sign in to the EMR when you start residency, let alone to practice in your specialty!

 

[wispers2u2]

I am really glad that people are talking about this problem. Keeping silent and suffering in silence is not the solution and no one should be subjected to live that way. The powerless should strive for ways to have their voices heard. I have started a petition addressing this issue on the White House's website. Please join me in signing and forwarding this petition to as many people as possible.
Dear friends,
I wanted to let you know about a new petition I created on We the People, a new feature on WhiteHouse.gov, and ask for your support. Will you add your name to mine? If this petition gets 25,000 signatures by March 09, 2012, the White House will review it and respond!
We the People allows anyone to create and sign petitions asking the Obama Administration to take action on a range of issues. If a petition gets enough support, the Obama Administration will issue an official response.
You can view and sign the petition here:
http://wh.gov/0xm
Here's some more information about this petition:
Take steps to reform the extremely corrupt and abusive medical education system which lacks any checks and balances.
The current medical education system entails a system where mainly during the clinical phase of training, the practice of medicine degenerates to an extremely malignant and abusive display of teaching physicians personal vendetta's. A part of the reason for this is because there are virtually no checks and balances and physicians who have gained their way to the tops of the administration in a teaching hospital can virtually do what ever they want with those below them. There is no governing body or unions in place to protect the trainee from any workplace violations. Most of these physicians essentially function as bullies, terrorizing those below them. This abuse is tolerated because trainee's live in fear of being fired and blacklisted, losing their careers if they are targeted.

 

[wispers2u2]

I am really glad that people are talking about this problem. Keeping silent and suffering in silence is not the solution and no one should be subjected to live that way. The powerless should strive for ways to have their voices heard. I have started a petition addressing this issue on the White House's website. Please join me in signing and forwarding this petition to as many people as possible.
Dear friends,
I wanted to let you know about a new petition I created on We the People, a new feature on WhiteHouse.gov, and ask for your support. Will you add your name to mine? If this petition gets 25,000 signatures by March 09, 2012, the White House will review it and respond!
We the People allows anyone to create and sign petitions asking the Obama Administration to take action on a range of issues. If a petition gets enough support, the Obama Administration will issue an official response.
You can view and sign the petition here:
http://wh.gov/0xm
Here's some more information about this petition:
Take steps to reform the extremely corrupt and abusive medical education system which lacks any checks and balances.
The current medical education system entails a system where mainly during the clinical phase of training, the practice of medicine degenerates to an extremely malignant and abusive display of teaching physicians personal vendetta's. A part of the reason for this is because there are virtually no checks and balances and physicians who have gained their way to the tops of the administration in a teaching hospital can virtually do what ever they want with those below them. There is no governing body or unions in place to protect the trainee from any workplace violations. Most of these physicians essentially function as bullies, terrorizing those below them. This abuse is tolerated because trainee's live in fear of being fired and blacklisted, losing their careers if they are targeted.[/QUOTE]

 

[NotAProgDirector]

My apologies.

What I meant was that medical school is designed to train you to function as a beginning intern. If you arrive at a program incompetent to be a beginning intern, it's not a program's responsibility to remediate deficiencies in your prior medical training. Obviously, programs are here to take you from a competent beginning intern into a competent solo practitioner.

 

[MD forever]

My apologies.

What I meant was that medical school is designed to train you to function as a beginning intern. If you arrive at a program incompetent to be a beginning intern, it's not a program's responsibility to remediate deficiencies in your prior medical training. Obviously, programs are here to take you from a competent beginning intern into a competent solo practitioner.

funny

 

[Dr. USMLE]

My apologies.

What I meant was that medical school is designed to train you to function as a beginning intern. If you arrive at a program incompetent to be a beginning intern, it's not a program's responsibility to remediate deficiencies in your prior medical training. Obviously, programs are here to take you from a competent beginning intern into a competent solo practitioner.

How is it that someone can be "incompetent to be a beginning intern" after satisfactorily completing medical school, Step 1 and 2 CLINICAL knowledge (and in some cases, Step 3), Step 2 CLINICAL SKILLS, obtaining 3 CLINICAL letters of recommendation (often including one from a sub-INTERNSHIP), as well as successfully interviewing?

Is it possible that the program director was grossly incompetent in hand picking this "lazy and incompetent" candidate out of a large pool of applicants (often numbering in the hundreds and even in the thousands)?

With great respect, it IS your responsibility to remediate deficiencies if YOU were the one responsible for selecting the candidate in question and YOU were lazy/incompetent in detecting deficiencies so marked that would later warrant an often career-terminating decision.

 

[member0007]

well here is the thing, the medical training system is a nightmare. the acgme does do some good and it's definitely better to have some system like acgme than not. on the other hand, acgme refuses to adjudicate on the behalf of a resident. who is then willing to adjudicate for an individual physician during the training years? the non-existent unions? well, they do not exist at every hospital, now do they?

so then, who will? the pricey lawyers that cannot be afforded by a trainees salary? really who? the hospitals' legal department? the hr? the gme? the dio? the program director? who? who assists the residents who request assistance? i can tell you that these are not the people who will assist you. it's not the people who run the harassment committees, nor the people who blame you for incoherent outbursts by a coworker. it's not the hospital who intends to destroy the minority, constantly threatens a minority, does not afford protection to minorities for a dissenting opinion, but consistently promotes the non-minorities, no matter what they are culpable of. it's the promotion of the non-minority with the concomitant harassment and destruction of minority in the immediate environment and in the appropriate context that sends a message and tells you exactly how a discriminatory institution really works. it's frowned upon and outright illegal but you know what, these institution also gets to hire lawyers and have an obscene amount of funding to prevent your success. they will break the law because they are arrogant and destructive. meanwhile, the residents are not allowed a union but nor are they are provided with an alternative.

it's time physician's in training across the country realized that FSLA does not apply to you because of the professional nature of your job. it's time you realized that many of these programs do accumulate a generous amount of wealth for directly from your training gme grant. but it's also time you realized that physicians in training do not have be subject to harassment, intimidation, retaliation, discrimination, punitive actions, and outright hostility.

what will protect you is an extensive record of the harassing and intimidating actions taken against you. bring the appropriate tools to meetings to record exactly what is being done. keep note of all the negative actions taken against you. be ready to speak for yourself, especially, in circumstances that preclude you from having adequate amount of legal counsel. don't worry about your former employer and their tactics. it's bound to be exposed for exactly what it is but worry about your own actions.

worry about your rights. it's important to know that blacklisting is illegal and a crime. it's important to know that your training record should be accessible to you and a potential employer. they are not allowed to fabricate lies. they have to allow you access to evaluations about yourself, ahem... if they sneak a horrible evaluation into your file without telling you or allowing to review and refute or comment, that's illegal and unacceptable according to ACGME.

if you are in an appeals process, the employer should not retaliate against you by taking further actions, until matters are resolved i.e. reporting you to the state etc. the employer should not prevent you from due process. however, that is often what happens to physicians who are discriminated against. the concerted effort to be punitive towards this individual far exceeds the drive to preserve their rights and maintain decorum. your employer or an arm of it which purports to physican wellness does not have the right to disclose your medical information to members of the hospital. that's hippa protected. that's illegal.

from my experience, i know just how far a hospital will go to prevent an individual from being successful. i know that this can have a destructive on an individuals well-being but so does your hospital. don't you think that they dont know exactly just how they are abusing you. they do and they intend to harm. but look at those people who are harassing you, and then realize one thing, you are better than them. you have your moral compass aligned to beliefs and principles that have gotten you far and will get you to where you need to go. stand up to them. stand up to their lies. don't buy into it. start asking questions about everything and learn. learn to be discerning. learn to be well rounded. don't be intimidated by those who hide behind a racist legal team etc.

also, don't be too civil or too nice or remotely subservient. this is the mistake that i made. i gave myself and those harassing me the same consideration. actually, what you have to do is to give yourself all the consideration and very little to people who harass or discriminate against you. yes, my problem was that i was not respected at all and the disrespect was rampant. no regard for me. no regard for my personal items. no regard for my contract. no regard for good faith and fair dealing. no regard for the years of training. no regard for me at all.

if there are other people out there who are in similar situations, i want to hear more about these events. i want to know what happened. i want to know if they made you repeat your harrowing experiences for months. if they reprimanded you. i want to know if you had to endure repeated verbal and written threats to your jobs. if people who support you were harassed by the administration to any degree. i want to know if they actively prevented you from being able to perform your work. i want to know the sordid details and exact methods. for example, list a specific instance, like this one - meeting without any known agenda with supervisors that deteriorate into intimidation such as no one will believe you, certain people (people who you have met once or twice) don't like you, so as to allow readers of this forum to understand the degree of abuse that the medical training system subjects on some of the physicians in training. imo and i imagine, most people, this should not be allowed.

 

[MD forever]

if there are other people out there who are in similar situations, i want to hear more about these events. i want to know what happened. i want to know if they made you repeat your harrowing experiences for months. if they reprimanded you. requested that you write self-reflections, then rewrite and recast them for months which was based on their sudden dissatisfaction, how they took more actions against you. i want to know if you had to endure repeated verbal and written threats to your jobs. if people who support you are harassed by the administration to any degree. i want to know if they actively prevented you from being able to perform your work. i want to know the sordid details and exact methods. for example, list a specific instance, like this one - meeting without any known agenda with supervisors that deteriorate into intimidation such as no one will believe you, certain people (people who you have met once or twice) don't like and why? etc, to allow readers of this forum to understand the degree of abuse that the medical training system subjects on some of the physicians in training. imo and i imagine, most people, this should not be allowed.

It seems you went through difficult experience as this threat is all about, accept my sympathy please. I have few questions though, You want to hear more about others experiences, May I inquire how will that benefit them? Is there plan how they can restore their career? Is it group therapy? Somebody started petition in the White house, Do you have any similar plan may be involve volunteer counseling etc?
I am just curious
Thank you

 

[wooster201106]

...Your PD doesn't necessarily need to give you guidance or help -- it sounds like you were seriously in over your head and help wasn't going to address the situation. Your PD is under no requirement to help you get your next position, either...

You're right. A PD is not really under any obligation to help out a resident with issues who may be struggling. The "not my problem" attitude, though, says a lot about the person and the PD. I think I can speak for many a resident when I say that I would want nothing to do with a program whose PD was as callous as the one you describe. If you're not willing to invest the time and effort in one of your best resources (i.e. residents), then you have no business being involved in GME administration at any level, much less as a PD. I'm sure there are residents who've struggled, but with the help of a compassionate PD went on to become excellent physicians.

Academically, we can assume that the residents in a particular program have been vetted, and are more or less on par with each other. But, not everyone arrives to residency with the same social support, resources, and set of circumstances. I think it's important to remember that both the residents and program share a common goal which is for the resident to successfully complete the program. With some assistance and guidance, those who could just have easily been written off can thrive. There will be residents who don't succeed despite this, but there are also those who are never given a chance.

With great respect, it IS your responsibility to remediate deficiencies if YOU were the one responsible for selecting the candidate in question and YOU were lazy/incompetent in detecting deficiencies so marked that would later warrant an often career-terminating decision.

Why bother trying to fix something when you can easily replace it? PDs have a luxury of which you and I can only dream. Because of the much larger pool of applicants than spots, a PD can easily replace you without thinking twice and never look back. The more desirable the program the easier it will be to find a suitable replacement while you on the other hand would be SOL and lucky to find a position, any position, ever again. Sounds fair, doesn't?

 

[peerie]

You want to hear more about others experiences, May I inquire how will that benefit them? Is there plan how they can restore their career? Is it group therapy?
Thank you

Yes, it is group therapy and yes it will help them. Talking with other residents who have experienced this is priceless. Since residents are often driven out in the same way and with the same comments and procedures, yes it is helpful to realize that programs use a very standard and well worn way of getting residents out of their program.

I have spoken to attendings, program directors and faculty of quite a few programs as well as many residents and yes - it is the same procedure, the same comments ("you appear to be anxious," "I was told I was too anxious," "we had a resident who struggled with anxiety and we had to let her go ..."). The best line I ever hear from a program was this: "you are too anxious and there must be something wrong with you. Maybe it is psychological, maybe you need outside help. If you cannot stop being so anxious we will terminate you." This was a resident who had been harassed no end and threatened with termination for very vague, un-defined deficiencies.

So yes, group therapy would be great. That way residents can learn that "it's not me, it's them." Or rather, it's the system.

The ultimate question is whether the resident is popular and well received into the culture of the program or whether the resident is not. Residents who 'fit' into the culture of the program can be very imperfect but graduate with the blessing of the program. On the other hand, residents who are also imperfect but somehow different or not a good fit into the program will be more likely to undergo the treatment described above. It is not simply a matter of this is a bad resident and we need to eject them, plenty of really bad residents, even dangerous or dishonest residents survive these environments and go on to practice. I think sometimes it is the honest residents who don't fit into a dishonest or poorly run program who are most likely to be pressured to leave by the tactics described above. It makes sense doesn't it? An honest healthy program will work with truly deficient residents, a dishonest program with poor integrity will demonstrate that by how they treat their residents - including those they force out.

 

[peerie]

Yes, I am certain there are situations where residents are unfairly targeted. And, there is no question that there is some "magnifying glass" type effect -- once a resident is "in trouble", everything they do is examined with a magnifying glass and you find problems. Those same problems might be present in other, but go unnoticed. So the pressure mounts, the resident's performance degrades, and termination ensues.

However, it is often difficult for a resident with real problems to have the insight to see them. It's "easy" to blame the system for your own failings. Residents often claim that "everyone does it" or that their behavior is not outside the norm.

This is what makes evaluation of residents so difficult. There are no objective tests of competence, and there won't be any. It will always be a subjective evaluation, and subjective evaluations are subject to bias.

Wise points, well said. If we know about the magnifying syndrome, maybe we could guard against it and protect a genuinely good resident who needs to get his/her sea legs a little in order to go on and do well. Maybe create a safer environment, since it can so easily become very explosive. On the other hand, some programs use this situation as an easy and really cruel way to drive out a resident they don't want.

In the end, medicine is not the noble profession we have often wanted to believe it is. At least, not anymore if it ever truly was. Today, it is a profession in very deep trouble and whether resident, attending or hospital - it is a very challenging environment. Many physicians would give anything to leave it.

 

[captaincrunch]

I agree that many residents get put under the magnifying glass; once it happens, it is very hard to reverse. Everything becomes fodder for criticism, even things that don't draw attention when done by other residents. It is also true that many residents who struggle in one program do better in another program or another field. Others who manage to get through their own program (albeit with some problems), may do fine once they are out of training. And certainly, there are programs that have malignant atmospheres and that are intolerant of those who don't play their internal politics well.

That being said, far too many medical students and residents are promoted when they shouldn't be. The fact that you passed your boards is not proof that you are a competent physician. Neither is the fact that you got through your clinical rotations. Too often, poor medical students are promoted when performance is sub-par because it is easier to simply pass a student than to remediate them. As a resident, I've had failing students on my team, and believe me, it's a lot of work to get them up to speed. It would be much easier to just pass them and let them become someone else's problem. But when that happens, they are often unprepared for internship. We do no favors to medical students by ignoring problems.

Contrary to popular belief in these forums, it is not easy to fire a resident. Each resident must be notified of their deficiencies in writing and given an opportunity to fix them. As an attending now, my residents have all done well, but our program has had a history (not many, thankfully) of prior residents who were terminated. It virtually guarantees a lawsuit. Every other resident must do extra work to cover the terminated resident's rotations. The resident's replacement may be taken out of the match or out-of-cycle which makes it more likely to hire another troubled resident.

Remember that not all deficiencies are clinical. A person can have an adequate clinical knowledge base, but fall behind in other areas. If you find yourself in the cross-hairs, you should ask yourself why that is. Why do other residents seem to get favored treatment while others do not. It may not be fair, but interpersonal skills are important. Medicine requires a lot of human interactions, not just with patients, but with other physicians, nurses, telephone operators etc. Arrogance/abusiveness is a common example of an attitude that gets recognized fast. It's true that charming residents do not tend to get into trouble.

There are also ethical issues that can land people in hot water. Drinking/drugs on the job and sexual relationships with patients are obvious examples, but other things include missing call, not keeping accurate records, lying on rounds, accessing patients' records inappropriately, etc. Mental/physical illness is interesting, and there may be protections under law. But when starting a program, we usually sign a form stating we have the physical and mental health to get through the program. It's worth noting that residents who fail their specialty boards (which are harder than step 3, by the way) are more likely to face disciplinary problems as well (e.g., the above behaviors). Poor academic performance, it seems, manifests itself in other ways.

These problems don't end in the "real world" either. I've seen far too many physicians have hospital privileges revoked, be sanctioned by medical boards, etc. Once the University of X graduates a resident, it can never be revoked. For the rest of the doctor's career they will be a University of X-trained doctor. It is important for programs to ensure that all of their graduates live up to their standards. It is not only important for the program's future, but also for the safety of future patients.

 

[WholeLottaGame7]

Wise points, well said. If we know about the magnifying syndrome, maybe we could guard against it and protect a genuinely good resident who needs to get his/her sea legs a little in order to go on and do well. Maybe create a safer environment, since it can so easily become very explosive. On the other hand, some programs use this situation as an easy and really cruel way to drive out a resident they don't want.

In the end, medicine is not the noble profession we have often wanted to believe it is. At least, not anymore if it ever truly was. Today, it is a profession in very deep trouble and whether resident, attending or hospital - it is a very challenging environment. Many physicians would give anything to leave it.

I'm fairly sure that medicine today is a hundred times more "cuddly" than it was 50 or even 25 years ago. I'm not saying the system is perfect; of course it isn't. Just that residency life now is cush compared to the old days.

 

[WholeLottaGame7]

I agree that many residents get put under the magnifying glass; once it happens, it is very hard to reverse. Everything becomes fodder for criticism, even things that don't draw attention when done by other residents. It is also true that many residents who struggle in one program do better in another program or another field. Others who manage to get through their own program (albeit with some problems), may do fine once they are out of training. And certainly, there are programs that have malignant atmospheres and that are intolerant of those who don't play their internal politics well.

That being said, far too many medical students and residents are promoted when they shouldn't be. The fact that you passed your boards is not proof that you are a competent physician. Neither is the fact that you got through your clinical rotations. Too often, poor medical students are promoted when performance is sub-par because it is easier to simply pass a student than to remediate them. As a resident, I've had failing students on my team, and believe me, it's a lot of work to get them up to speed. It would be much easier to just pass them and let them become someone else's problem. But when that happens, they are often unprepared for internship. We do no favors to medical students by ignoring problems.

Contrary to popular belief in these forums, it is not easy to fire a resident. Each resident must be notified of their deficiencies in writing and given an opportunity to fix them. As an attending now, my residents have all done well, but our program has had a history (not many, thankfully) of prior residents who were terminated. It virtually guarantees a lawsuit. Every other resident must do extra work to cover the terminated resident's rotations. The resident's replacement may be taken out of the match or out-of-cycle which makes it more likely to hire another troubled resident.

Remember that not all deficiencies are clinical. A person can have an adequate clinical knowledge base, but fall behind in other areas. If you find yourself in the cross-hairs, you should ask yourself why that is. Why do other residents seem to get favored treatment while others do not. It may not be fair, but interpersonal skills are important. Medicine requires a lot of human interactions, not just with patients, but with other physicians, nurses, telephone operators etc. Arrogance/abusiveness is a common example of an attitude that gets recognized fast. It's true that charming residents do not tend to get into trouble.

There are also ethical issues that can land people in hot water. Drinking/drugs on the job and sexual relationships with patients are obvious examples, but other things include missing call, not keeping accurate records, lying on rounds, accessing patients' records inappropriately, etc. Mental/physical illness is interesting, and there may be protections under law. But when starting a program, we usually sign a form stating we have the physical and mental health to get through the program. It's worth noting that residents who fail their specialty boards (which are harder than step 3, by the way) are more likely to face disciplinary problems as well (e.g., the above behaviors). Poor academic performance, it seems, manifests itself in other ways.

These problems don't end in the "real world" either. I've seen far too many physicians have hospital privileges revoked, be sanctioned by medical boards, etc. Once the University of X graduates a resident, it can never be revoked. For the rest of the doctor's career they will be a University of X-trained doctor. It is important for programs to ensure that all of their graduates live up to their standards. It is not only important for the program's future, but also for the safety of future patients.

The bolded part is key. Surviving residency is not just about brown-nosing your attendings; you'd better be brown-nosing everybody in that building, and twice on Sundays. If people like you, you get more slack. That's just the way the world works, and it's not going to change anytime soon. Easier to change your attitude than to change an entire system.

 

[Shinken]

The bolded part is key. Surviving residency is not just about brown-nosing your attendings; you'd better be brown-nosing everybody in that building, and twice on Sundays. If people like you, you get more slack. That's just the way the world works, and it's not going to change anytime soon. Easier to change your attitude than to change an entire system.

Very true.

I wouldn't necessarily say brown-nosing is needed, but just simple, common, basic courtesy not only to attendings but to nurses, techs, and other staff. If you come across as an arrogant, entitled "hot shot" intern or resident then don't expect people to treat you well or stand up for you.

 

[Top Gun]

Very true.

I wouldn't necessarily say brown-nosing is needed, but just simple, common, basic courtesy not only to attendings but to nurses, techs, and other staff. If you come across as an arrogant, entitled "hot shot" intern or resident then don't expect people to treat you well or stand up for you.

Exactly. You should treat everyone with politeness and respect. But you don't need to brown-nose. If you brown-nose, then everyone will take advantage of you. Residents who are "too nice" often end up getting more work, or extra calls, dumped on them because they cannot say no.

 

[45408]

How is it that someone can be "incompetent to be a beginning intern" after satisfactorily completing medical school, Step 1 and 2 CLINICAL knowledge (and in some cases, Step 3), Step 2 CLINICAL SKILLS, obtaining 3 CLINICAL letters of recommendation (often including one from a sub-INTERNSHIP), as well as successfully interviewing?

You've never met an intern who was clearly sub-par? I worked with one in med school who was clearly not up for the challenge. Fortunately, she wasn't going to be going into internal medicine, the rotation I met her on, but it was just a required rotation. I'm sure she'll be fine in her chosen field, but she was incompetent, several months into the year.

Is it possible that the program director was grossly incompetent in hand picking this "lazy and incompetent" candidate out of a large pool of applicants (often numbering in the hundreds and even in the thousands)?

With great respect, it IS your responsibility to remediate deficiencies if YOU were the one responsible for selecting the candidate in question and YOU were lazy/incompetent in detecting deficiencies so marked that would later warrant an often career-terminating decision.

I like how you try to completely turn it around, but I'm not buying it. It's always a two-way street.

 

[member0007]

hmm... i don't like comparing medicine to 25 or 50 or etc years ago. people believed a whole lotta crazy stuff about medicine. i think that program directors have a duty to residents to follow up on complaints and intervene. i guess you can teach medicine but not good judgement or integrity :-/

 

[ZYX321]

I have looked through a fair amount of this long thread an not found this posted, my apologies if it has already been extensively addressed.

To attendings, PDs, admin:
If you are a resident who is being considered for termination, would it be better to keep working your hardest at proving your competence so as to not get fired (with the chance that you may get fired anyways) or step away and resign beforehand? Is there realistically any difference between these two options in regards to attempting to get into a new residency slot in the future (same field)?

 

[shopsteward]

If you are a resident who is being considered for termination, would it be better to keep working your hardest at proving your competence so as to not get fired (with the chance that you may get fired anyways) or step away and resign beforehand? Is there realistically any difference between these two options in regards to attempting to get into a new residency slot in the future (same field)?

I'll start with the caveat that I am not an attending, PD or admin. I have helped people under threat of termination, though.

Working "harder" may or may not help you. Working "smarter" almost certainly will.

I don't know what your individual situation is. You need to have read up on and fully understand the processes you are subject to in your program which relate to performance requirements and termination. If necessary, make yourself a chart setting out all the steps which lead to termination and mark where you are on it. That should give you an idea whether your position is still retrievable or not.

Working "smarter" means making a list of the problems the program has identified with your performance. Then list against each problem what you need to do in order 1) to resolve the issue and 2) to be able to prove that you have resolved the issue. For instance, you need to be able to demonstrate "You said on date X that I couldn't do Y, I got additional training/experience/demonstrate changed behaviours on the following dates, now I can do Y and Z attending saw me do it and recorded that it was done properly." You need to do this for every issue which have ever been raised in relation to your peformance. You need to do this, in relation to each identified issue with your performance, before the date for the next step in the process which would lead to your termination, or at least be able to demonstrate improvement.

I should say at this stage that your personal feelings about your level of peformance or the fairness of your treatment are irrelevant. You have no choice but to go with the program's assessment of you if you are to retrieve the situation. Keep your own opinions about your situation and about other people in the program out of the matter entirely, and treat it all as dispassionately as you can.

You need to identify the people in your program, at whatever level, who will be prepared to help you with all of this, and ask for their help. If you go to them with a plan which shows that you want to address all of the issues raised and have worked out how you can do it, there is a good chance you will get their help.

If you can't do all of this, you may need to negotiate an agreed exit. What you mainly need if you are going to leave a program is an agreement about how many months credit you will get for the current year, how good your references will be, and whether you will get any assistance in finding a new residency. You will probably either need to brush up on your negotiating skills, or get someone to help you, if you are to get the best outcome.

Good luck.

 

[satakay]

I am one of such unfortunate individuals/Residents. I was terminated in May 2009 right couple of days before my PGY3 contract renewal. I went trhough hell and really feel all those who are undergoing or went thruogh this. I was suicidal, homocidal, but after a year I stopped looking back, and decided to move on.
I am also extremely thankful to those States, where you can be licensed with one year of inernship.
Anyway for the last two years I am practicing independently, and believe me doing a lot better job than my other so called certified coleagues.

I am thankful to the poster who brought this important issue, and I am willing to help other Victims (of this brutal and senselless system) like myself.
Just signed the petition and request all of you to sign it please.
http://wh.gov/0xm

 

[The Hamster]

Aa

 

[Buzz Me]

Unfortunately once you've been fired by your residency program, your chances of finding another spot at a different program are going to be near-impossible. Assuming you aren't being blacklisted, your new program is going to want a reference (or at least a phone call) from your previous program director...and then the reason for your dismissal will be discussed. Rarely there are extenuating circumstances, but these usually result in the resident being put on probation or remediation...for a resident to actually get fired is a big, BIG red flag.

In the end, though, as painful as it may be, if a career in medicine just didn't work out for you, be thankful that you discovered this during your internship, and not when you're years and years in.

 

[Domenech]

So the resident who gets fired really has absolutely no chance of stepping back into another residency program, even if it's some "lowly" program?

But the worst is hearing how the rest of your medical school class has succeeded and are now getting board certified. You want to be happy for all of them and be a part of it, but all it does is remind you of your failure and make you feel jealous.

I don't even want to imagine a scenario like that.

 

[epsilonprodigy]

May I just say that, as a rising MS-1, this thread scares the hell out of me.

My question is this: surely most residents taking a significant beating, are belittled and berated, kicked out of the OR for getting pimp questions wrong, fall behind, make mistakes, and find themselves on the receiving end of a few wacky ego-driven tantrums from attendings. Unfortunately enough, it is my understanding that this sort of thing is "normal."

Given that, how do you tell the difference between that kind of "normal" and actually being in trouble or not moving along well enough in your learning? I'm hoping to grow a thicker skin with time and training, but the sort of treatment I hear residents talking about most of the time would probably have me thinking I was next on the chopping block. Thoughts?

 

[Chakrabs]

Being treated like garbage is most decidedly NOT normal. Not in medical school and not in residency. Does it happen from time to time? Yes. Are there certain individuals that consistently do this? Yes. However I have spent tons of time in surgical programs throughout the country and have never seen any program consistently browbeat their residents across the board.

 

[Buzz Me]

So the resident who gets fired really has absolutely no chance of stepping back into another residency program, even if it's some "lowly" program?

Depends on the situation...but in the case of the poster a couple posts before mine (above), being put on probation...then failing remediation is a bad sign.

However I have spent tons of time in surgical programs throughout the country and have never seen any program consistently browbeat their residents across the board.

How many programs have you seen? Remember that as a student you also may not be privy to some of the beatdowns that residents receive in private.

Of course it's not normal for programs to consistently beat on their residents (those programs are labelled "malignant"). But it certainly happens, unfortunately, at some places. A few names come to mind.

 

[Per4mer8]

May I just say that, as a rising MS-1, this thread scares the hell out of me.

My question is this: surely most residents taking a significant beating, are belittled and berated, kicked out of the OR for getting pimp questions wrong, fall behind, make mistakes, and find themselves on the receiving end of a few wacky ego-driven tantrums from attendings. Unfortunately enough, it is my understanding that this sort of thing is "normal."

Given that, how do you tell the difference between that kind of "normal" and actually being in trouble or not moving along well enough in your learning? I'm hoping to grow a thicker skin with time and training, but the sort of treatment I hear residents talking about most of the time would probably have me thinking I was next on the chopping block. Thoughts?

Holy crap are you ahead of the "psych myself out as a med-student" journey. Browsing the Resident issues forum and specifically the worst of the worst thread. You skipped the "holy crap how can I remember all this Step 1 crap" and went straight to the "how do I deal with getting fired" posts...... Congrats.

In all seriousness, all of med school is hard but much of it is how you look at it and approach it. You will occasionally get yelled at or made to feel absolutely ******ed, but you know what? You aren't, and the attending doesn't truly think that either. Interpersonal interactions are in constant flux and acted on by numerous factors/stressors. Everyone has a bad day and you will have more than a few. The secret is to put in the work and go with the flow, treat people with respect and at the same time have confidence in yourself.

 

[michaelrack]

, and the attending doesn't truly think that either.

most of the time

 

[docbamboo]

That's how I feel right now. I am happy for them but I am reminded that I didn't finish.
I wish it were just a job but it was not. I dedicated so much for this. I sometimes beat my head up for not going into other fields that have shorter training and less competition.
It is embarrassing and I don't want to talk to my friends about it. I used to be a happy positive person but now I am not.

 

[IlDestriero]

How is it that someone can be "incompetent to be a beginning intern" after satisfactorily completing medical school, Step 1 and 2 CLINICAL knowledge (and in some cases, Step 3), Step 2 CLINICAL SKILLS, obtaining 3 CLINICAL letters of recommendation (often including one from a sub-INTERNSHIP), as well as successfully interviewing?

Is it possible that the program director was grossly incompetent in hand picking this "lazy and incompetent" candidate out of a large pool of applicants (often numbering in the hundreds and even in the thousands)?

With great respect, it IS your responsibility to remediate deficiencies if YOU were the one responsible for selecting the candidate in question and YOU were lazy/incompetent in detecting deficiencies so marked that would later warrant an often career-terminating decision.

You can't remediate lazy and careless.
When you've been warned, given official notice and are still making dangerous or careless mistakes that could cause patient injury your only ethical choice is termination. I've seen it in anesthesia. It's the residents responsibility to get their act together or pack up their locker.

 

[peach4me]

You can't remediate lazy and careless.
When you've been warned, given official notice and are still making dangerous or careless mistakes that could cause patient injury your only ethical choice is termination. I've seen it in anesthesia. It's the residents responsibility to get their act together or pack up their locker.

Shut up!!! Maybe you should be unfairly terminated and see how it feels. . . Quite often, excellent residents of terminated simply because they don't personally "fit in " with the status quo and then the program director say they have deficiencies, when none exist. Its extremely sad and unethical.

 

[IlDestriero]

Shut up!!! Maybe you should be unfairly terminated and see how it feels. . . Quite often, excellent residents of terminated simply because they don't personally "fit in " with the status quo and then the program director say they have deficiencies, when none exist. Its extremely sad and unethical.

I'm replying to the post above suggesting that it's the PDs problem to remediate every bad resident. Not anyone else's situation. So don't get all bent out of shape. I didn't even read any of the thread other than some of the last page. Though your use of "quite often" is a gross overstatement of the reality.
I've never seen an "excellent resident" treated poorly because they don't fit in. By definition, they're excellent, so they get treated well, made chief, etc. I want to be surrounded by excellent residents. It makes my job easier. I've seen cocky know it all residents and fellows struggle and get passed over for fellowship spots and faculty appointments, much to their dismay and confusion though. Of course my n is only 5 institutions. There may be some shady malignant programs out there somewhere.
Getting back to my post, anesthesia is an applied critical care field. Lazy and careless can cost lives, and you can't unpush a drug. If you're easily distractible, lazy, careless, etc. it's not the field for you. The couple residents I've seen fired absolutely deserved it. They had caused harm and they absolutely would again. The intern thrown out of my class was an absolute disaster who after attempted remediation was appropriately deemed untrainable. You would not believe me if I told you some of the things that he did. He was also shocked that he was fired, and as a military officer in training, it had some particularly bad repercussions. He ended up being reassigned to the MSC to push paper around for a few years. I doubt he's a physician now, and he probably still thinks he was wronged.

 

[45408]

May I just say that, as a rising MS-1, this thread scares the hell out of me.

My question is this: surely most residents taking a significant beating, are belittled and berated, kicked out of the OR for getting pimp questions wrong, fall behind, make mistakes, and find themselves on the receiving end of a few wacky ego-driven tantrums from attendings. Unfortunately enough, it is my understanding that this sort of thing is "normal."

Given that, how do you tell the difference between that kind of "normal" and actually being in trouble or not moving along well enough in your learning? I'm hoping to grow a thicker skin with time and training, but the sort of treatment I hear residents talking about most of the time would probably have me thinking I was next on the chopping block. Thoughts?

LOL, that would be the day. No one in my program would ever kick me out of the OR for that kind of nonsense.

 

[J-Rad]

A reminder to keep it civil and professional. While this topic can engender strong emotions, everyone can and does bring different perspectives and experiences with them. Please be respectful.

 

[Arcan57]

I have avoided beginning a debate in this thread but I now feel compelled to do so. Please re-read what you have written above. Based only on that, is there not a far, far more likely explanation for her behavior than incompetence? Ironically, labeling this intern as incompetent is actually a lazy explanation.

Competence is about the ability to successfully perform a task. If you are too lazy to apply yourself, then that can be a cause of incompetence. Incompetence and laziness are not mutually exclusive. Also, at the intern level, laziness leads to patient harm. Underperforming on a rotation simply because it's not something you are interested in is concerning.

There is nothing to buy into as I have not made any assumptions. I would also like to clarify that I feel that aPD is a valuable contributor to this forum and will probably help more terminated residents than I am capable of doing. With that said, you must appreciate the hypocrisy of his position on this issue. He admits that all of the residency evaluations in his program are necessarily subjective. He, like all program directors, uses objective data in choosing prospective residents to interview and rank. The objective data (Step 1, 2, CS and to a lesser extent, transcripts) play a very heavy role in this selection process. When it comes to resident termination, he feels that although (1) subjective data is necessarily prone to biases, prejudices, politics, personality conflicts, and other interpersonal non-sense that objective data is not and (2) objective data is relied on most heavily in the competitive selection process, the subjective resident evaluations weigh more than all previous objective data on the same resident. Please keep in mind that this same objective data was weighed (usually far) more heavily than previous subjective data (letters of recommendation, personal statement, ERAS application activities) for the overwhelming majority of programs. In summary, aPD's position is that the subjective resident evaluations (even over a very short period of time, unlike a MSPE based on years of subjective data) is given far more weight in resident terminations despite all actual evidence to the contrary in the form of objective, internationally standardized examinations. That is, the subjective evaluations (prone to all of the aforementioned interpersonal chaos) is weighed more than the standards established by the resident's medical school alma mater and the National Board of Medical Examiners. This is despite the fact that the same PD relied very heavily on this information in choosing the resident to begin with.

The problem is that competency in med school is not equal to competency as a resident. It's not quite as opaque as drafting successful NFL quarterbacks, but all the objective data doesn't tell a PD if you care about your patients or can't play well in a team setting. All the subjective data tends to be biased in favor of the med student (I'm sure almost no one has in their LOR that they neglected patient care duties to study for the shelf exam, for example). Maybe more weight should be given to subjective data, but then how do you keep the already rampant inflation of the subjective assessment of med students in check?

PDs have imperfect methods of assessing a med student's chance of successfully completing training. They can't personally audition every applicant for long enough to get an accurate picture of the resident, so they rely on surrogate markers. These surrogate markers (board scores, SLORs, class rank) have value, but are not 100% sensitive and specific.

Your argument is the equivalent of saying you can't cut a busted draft pick because they did so well in college and at the combine. It sucks for the draft pick because they've worked very hard to get where they are, but it produces a better quality product. Nobody wants to have to watch Ryan Leaf start at quarterback despite clearly being unable to play at the NFL level, and no one wants to be taken care of by an incompetent doctor even if they got a 260 on Step I and II.

 

[45408]

I have avoided beginning a debate in this thread but I now feel compelled to do so. Please re-read what you have written above. Based only on that, is there not a far, far more likely explanation for her behavior than incompetence? Ironically, labeling this intern as incompetent is actually a lazy explanation.

She was lazy, making her incompetent.

There is nothing to buy into as I have not made any assumptions. I would also like to clarify that I feel that aPD is a valuable contributor to this forum and will probably help more terminated residents than I am capable of doing. With that said, you must appreciate the hypocrisy of his position on this issue. He admits that all of the residency evaluations in his program are necessarily subjective. He, like all program directors, uses objective data in choosing prospective residents to interview and rank. The objective data (Step 1, 2, CS and to a lesser extent, transcripts) play a very heavy role in this selection process. When it comes to resident termination, he feels that although (1) subjective data is necessarily prone to biases, prejudices, politics, personality conflicts, and other interpersonal non-sense that objective data is not and (2) objective data is relied on most heavily in the competitive selection process, the subjective resident evaluations weigh more than all previous objective data on the same resident. Please keep in mind that this same objective data was weighed (usually far) more heavily than previous subjective data (letters of recommendation, personal statement, ERAS application activities) for the overwhelming majority of programs. In summary, aPD's position is that the subjective resident evaluations (even over a very short period of time, unlike a MSPE based on years of subjective data) is given far more weight in resident terminations despite all actual evidence to the contrary in the form of objective, internationally standardized examinations. That is, the subjective evaluations (prone to all of the aforementioned interpersonal chaos) is weighed more than the standards established by the resident's medical school alma mater and the National Board of Medical Examiners. This is despite the fact that the same PD relied very heavily on this information in choosing the resident to begin with.

I stopped right about there.

 

[shopsteward]

In summary, aPD's position is that the subjective resident evaluations (even over a very short period of time, unlike a MSPE based on years of subjective data) is given far more weight in resident terminations despite all actual evidence to the contrary in the form of objective, internationally standardized examinations. That is, the subjective evaluations (prone to all of the aforementioned interpersonal chaos) is weighed more than the standards established by the resident's medical school alma mater and the National Board of Medical Examiners. This is despite the fact that the same PD relied very heavily on this information in choosing the resident to begin with.

Interviews are a very subjective way of choosing trainees/employees, even when significant efforts are made to give them formal structures and provide equivalence as between candidates. Subjective evaluations at interview can be seen as being the first part of the subjective performance evaluations which will come through the job. That is why face to face interviews are such an important part of the recruitment process - if both parties think an interview is successful, it's as good an indicator as any that the subsequent working relationship will be successful.

As for the importance of examination results, their worth is in enabling the passing candidate to continue to the next stage. After the first week of undergrad, no-one cares what high school results got you to university. If you've got to post-graduate studies, your first degree gets forgotten pretty quickly. Once you start on the job training, it's only in the rarest of cases that where you did your graduate studies continues to matter (eg Oxbridge and the Ivy League first, the rest pretty much nowhere, always depending on subject and special circs). Once you are a fully qualified professional, where you trained usually becomes similarly irrelevant: within a few months your reputation will depend almost entirely on how well you do your job in terms of technical skills and personal interactions.

The leap from being a student to being a working professional, even one still in training, is enormous, and many people don't recognise the differences until it's too late for them. It helps enormously if people have previous experience of holding down a job over a significant period of time. And as a matter of personality, some people can keep their emotions out of their personal working situation, get their heads down and approach what needs to be done in a detatched, professional manner while others get too personally emotionally invested and end up not seeing the wood for the trees. If you are the latter type of person and also inexperienced in the workplace, the vibes you pick up from interview are vital: cut out all considerations other than "will I be happy with these people and will they be happy with me?"

 

[JGimpel]

I'm glad that I haven't gone through the turmoil some of the posters in this thread have gone through and wanted to congratulate you on your courage and ability to actively pursue your dreams, even in the light of such adversity. I came upon this thread by mention of it in another thread and it's given me some great ways to approach the office politics of my institution that I would not have otherwise thought of.
Good luck to you all and thanks again for sharing.

 

[umean2tellme]

This was an interesting read. The one thing I take away from it is that self-awareness is extremely important in residency.

 

[gutonc]

This was an interesting read. The one thing I take away from it is that self-awareness is extremely important in residency.

The 2nd thing you should take away is a corollary to the first.

Most people in medicine have absolutely no self-awareness. Most of the time that's not an issue...unless it is.

 

[metabolite]

Question - is it much better to resign on my own, than waiting for my program to terminate me? I already got contract non-renewal notice but I'm definitely feeling that I will be asked to leave sometime in the middle of the year.

I posted same question on another thread - sorry if this annoys anyone...

 

[kulley123]

I'm not a resident, so take my opinion for what it is.

I have worked as an EMT/paramedic for a couple different companies, and each has a hazing/teaching process that seems similar to what you guys have described. There's name calling, lots of public shaming, etc. You also need to get 'cleared' by a training officer - clearly the stakes aren't anywhere near as high as for a resident, since if you don't make the cut... you apply to a different company.

But what stuck out at me was the long discussion earlier about 'competency'. As an outsider looking in, I found the arguments really.. strange, especially from the 'PD'. I find it incredibly pompous and self-serving to imply that being an MD requires some magic level of 'competence', and those without it have themselves to blame. I'm pretty sure that if an intelligent person is genuinely motivated, they can be taught just about anything - the key for me is motivation. The people I've seen fail in my profession were either stupid (bluntly) or unmotivated. Even those that aren't high intellects, with a lot of drive, do far better then those that are smart but lazy.

So in my opinion - reading through these messages from 'terminated' residents - unless they all have a spectacular lack of insight, the problem is with the system.

 

[mcl]

I'm not a resident, so take my opinion for what it is.

...But what stuck out at me was the long discussion earlier about 'competency'. As an outsider looking in, I found the arguments really.. strange, especially from the 'PD'. I find it incredibly pompous and self-serving to imply that being an MD requires some magic level of 'competence'...

Just to explain a little of why such an odd word gets thrown about in a forums like this one: "Competency" has become a standard in graduate medical education through the direction of the ACGME (the body that accredits residency programs) and their Outcomes Project. It maintained that merely being in a residecy training program for a specified number of years isn't enough to ensure that a physician was safe to practice independently after graduation. They developed a set of six competencies and phased in evaluation by competency over several years, hoping to make the evaluation process a little more standardized and a little less subjective (with varying degrees of success). Now every educational objective must be based on and tied to one or more of those six competencies. The plan for the future is to couple the competencies with specific milestones for every phase of graduate medical education--another odd word that will be entering the GME lexicon.

 

[Arcan57]

I'm not a resident, so take my opinion for what it is.

I have worked as an EMT/paramedic for a couple different companies, and each has a hazing/teaching process that seems similar to what you guys have described. There's name calling, lots of public shaming, etc. You also need to get 'cleared' by a training officer - clearly the stakes aren't anywhere near as high as for a resident, since if you don't make the cut... you apply to a different company.

But what stuck out at me was the long discussion earlier about 'competency'. As an outsider looking in, I found the arguments really.. strange, especially from the 'PD'. I find it incredibly pompous and self-serving to imply that being an MD requires some magic level of 'competence', and those without it have themselves to blame. I'm pretty sure that if an intelligent person is genuinely motivated, they can be taught just about anything - the key for me is motivation. The people I've seen fail in my profession were either stupid (bluntly) or unmotivated. Even those that aren't high intellects, with a lot of drive, do far better then those that are smart but lazy.

So in my opinion - reading through these messages from 'terminated' residents - unless they all have a spectacular lack of insight, the problem is with the system.

Being an MD does require a certain amount of competency. It's orders of magnitude more difficult to be a competent physician than it is to be a competent EMT or medic. Lazy is lethal in medicine, but at the physician level it's not the only deadly sin. And if you've read through these threads you've surely seen that many of the terminated residents had profound lack of insight. And some of them looked good in the combine but couldn't hack it in the pros. It happens and its tragic that someone would go $200k+ in debt before finding out they couldn't be successful in their chosen field.