Terminating residents

[wholeheartedly]

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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.

As was noted, a surprising number of them are spectacularly lacking in insight. Though I'm not counting out problems with the system either.

 

[umean2tellme]

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.

It really does suck to go into debt before realizing you aren't really cut out for what you spent 8 or so years striving towards. But in the end I'd rather get terminated in residency and still be young enough to move on with my life (easier said than done) than to complete residency and end up killing people.

 

[kulley123]

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.

I think you would do well to stay away from these types of comparisons..

I may have stated my point poorly - the finished product of any profession should meet certain objective/subjective 'competencies', but a trainee doesn't have to.. this is what training is for, no? I also think the 6 'competencies' are a fine example of turd polishing; you can polish and complicate the concept of subjective grading all you want, its still subjective.

I don't mean to get drawn into any arguments; it is what it is. I also think it's a waste of time to sit back and judge some of the people that have posted here in relative anonymity.. but I have no doubt it's a deeply flawed system, as are some of the 'logical' arguments in defense of it.

 

[smq123]

I think you would do well to stay away from these types of comparisons..

I may have stated my point poorly - the finished product of any profession should meet certain objective/subjective 'competencies', but a trainee doesn't have to.. this is what training is for, no? I also think the 6 'competencies' are a fine example of turd polishing; you can polish and complicate the concept of subjective grading all you want, its still subjective.

I don't mean to get drawn into any arguments; it is what it is. I also think it's a waste of time to sit back and judge some of the people that have posted here in relative anonymity.. but I have no doubt it's a deeply flawed system, as are some of the 'logical' arguments in defense of it.

In some ways, residents ARE finished products - they completed med school, which means that they should have some idea of taking care of patients, some idea of accepting limitations, and some idea of how to use feedback to make themselves better. So yes, while residents are still "trainees," they have still completed professional school.

If you don't mean to get drawn into any arguments, why use such language ("deeply flawed system," "turd polishing,") when, as a pre-med, you have no first hand exposure to residency?

 

[Arcan57]

I think you would do well to stay away from these types of comparisons..

Why? Are you going to argue my point regarding EMT/medic vs doc degree of difficulty?

 

[IlDestriero]

Well, if you don't polish your turd enough, you will find yourself lacking in one or more of the six clinical competencies that are required for you to graduate. At that point you will find yourself on the termination list. If you're deemed trainable by the faculty, you may be allowed to remediate.
It's not an apprenticeship at the foundry.

 

[kulley123]

Why? Are you going to argue my point regarding EMT/medic vs doc degree of difficulty?

No, I think those arguments are best left for the insecure. I will say that many docs would make terrible paramedics, just as many paramedics would make terrible doctors.. The point is they're different, and by making those comparisons you sound like you're trying to prove being a doctor is 'the hardest' - this is both pointless and wrong.

Well, if you don't polish your turd enough, you will find yourself lacking in one or more of the six clinical competencies that are required for you to graduate. At that point you will find yourself on the termination list. If you're deemed trainable by the faculty, you may be allowed to remediate.
It's not an apprenticeship at the foundry.

I agree. But I don't have to like it.

 

[kulley123]

In some ways, residents ARE finished products - they completed med school, which means that they should have some idea of taking care of patients, some idea of accepting limitations, and some idea of how to use feedback to make themselves better. So yes, while residents are still "trainees," they have still completed professional school.

If you don't mean to get drawn into any arguments, why use such language ("deeply flawed system," "turd polishing,") when, as a pre-med, you have no first hand exposure to residency?

The word 'finished' doesn't leave much room for doubt. If a 'finished product' requires further training, by definition, it is not finished. This would be an example of what I referred to as a 'strange argument'.

This will also be my final comment on this topic. You all clearly disagree with my opinion, and I see this discussion rapidly disintegrating. Agree to disagree.

 

[Dral]

the finished product of any profession should meet certain objective/subjective 'competencies', but a trainee doesn't have to.. this is what training is for, no? I also think the 6 'competencies' are a fine example of turd polishing; you can polish and complicate the concept of subjective grading all you want, its still subjective.

Boards

Suggest an objective method of grading competency other than knowledge. I'd like to hear it. You've heard of USMLE CS, yes?

MDs have MoC and CME.

The finished product of a physician is the day they retire. We are lifetime learners. I'm not saying other professions are not, but it's one of the things that should hopefully draw individuals to become physicians. Finishing residency is just one of the things we do in that lifetime so we are in essence never really finished products.

 

[mercaptovizadeh]

What are the qualities of an excellent intern? I think that's what would be most important for us to know. Are these qualities general or field-specific? What are things that you do not expect of the intern that you do expect of the attending (just so we're clear that this is a training position and not a finished product)?

And what is meant by "lazy intern"? Is this someone who isn't at the appropriate knowledge base? Doesn't call/follow up consults on time? Doesn't complete progress notes/DC summaries in a timely manner? Misses important problems in the patient? Or are we talking about something else here?

 

[Arcan57]

What are the qualities of an excellent intern? I think that's what would be most important for us to know. Are these qualities general or field-specific? What are things that you do not expect of the intern that you do expect of the attending (just so we're clear that this is a training position and not a finished product)?

And what is meant by "lazy intern"? Is this someone who isn't at the appropriate knowledge base? Doesn't call/follow up consults on time? Doesn't complete progress notes/DC summaries in a timely manner? Misses important problems in the patient? Or are we talking about something else here?

An excellent (mid-year) intern can identify worsening patient condition, ensure that a plan of care is carried out, handle routine nursing calls without requiring senior level involvement, give a coherant presentation during rounds with pertinent positives and negatives, and is beginning to generate their own plan of care on patients (even if they aren't acting independently).

An attending is expected to be able to act autonomously within the scope of their field.

 

[QofQuimica]

What are the qualities of an excellent intern? I think that's what would be most important for us to know. Are these qualities general or field-specific? What are things that you do not expect of the intern that you do expect of the attending (just so we're clear that this is a training position and not a finished product)?

I think the biggest thing that makes an excellent intern is that the person makes an effort to be an excellent intern. Seriously, the job is not rocket science. Show up when and where you're supposed to, try to help your team, do what's right for the patients even if it means putting yourself out once in a while, accept criticism gracefully, and keep trying to improve.

And what is meant by "lazy intern"? Is this someone who isn't at the appropriate knowledge base? Doesn't call/follow up consults on time? Doesn't complete progress notes/DC summaries in a timely manner? Misses important problems in the patient? Or are we talking about something else here?

It could be some of any of that, but to me, a lazy intern is someone who doesn't pull their weight and then other people have to pick up their slack. So, for example, leaving scut work for the next person to do, signing patients out without even a rudimentary plan (or giving a worthless signout), regularly being late to arrive and early to leave, blowing off the med students so that other people always end up precepting them, and otherwise just not doing their fair share of the work. Every program has "that guy" or "that gal," and the rest of the residents hate them. Don't be that person.

 

[45408]

No, I think those arguments are best left for the insecure. I will say that many docs would make terrible paramedics, just as many paramedics would make terrible doctors.. The point is they're different, and by making those comparisons you sound like you're trying to prove being a doctor is 'the hardest' - this is both pointless and wrong.

I don't know if being a physician is "the hardest," but it's certainly much harder than being an EMT/paramedic. I was an EMT and worked on a rig for several years in college/med school.

 

[IlDestriero]

I don't know if being a physician is "the hardest," but it's certainly much harder than being an EMT/paramedic. I was an EMT and worked on a rig for several years in college/med school.

Whatever man. Let's see you try to establish IV access in a trauma patient.
Oh, wait a second...

 

[Top Gun]

I don't know if being a physician is "the hardest," but it's certainly much harder than being an EMT/paramedic. I was an EMT and worked on a rig for several years in college/med school.

They're both difficult, but in different ways. As an EMT, you're more likely to be around burning buildings or cars, downed power lines, or in rough neighborhoods with street gang members trying to shoot you, while, as a physician, you're in a more controlled environment like the hospital or an air-conditioned office. But, as an EMT, providing the actual medical care is much more straightforward. Its just basic first aid and CPR. As a physician, your medical decision-making is much more complex and you do much more complicated procedures.

 

[metabolite]

Out of curiosity... If there was a program in which 15 residents that were terminated in the past five years were all minority/female while graduating class has been 99.5% Caucasian... Would that intrigue anyone to look into it?

 

[IlDestriero]

Out of curiosity... If there was a program in which 15 residents that were terminated in the past five years were all minority/female while graduating class has been 99.5% Caucasian... Would that intrigue anyone to look into it?

The ACLU might be interested if the terminated folks felt discriminated against. That's a lot of dismissed residents.

 

[K31]

Out of curiosity... If there was a program in which 15 residents that were terminated in the past five years were all minority/female while graduating class has been 99.5% Caucasian... Would that intrigue anyone to look into it?

The ACLU might be interested if the terminated folks felt discriminated against. That's a lot of dismissed residents.

Seems to me that the EEOC would be a better place to start

 

[Siggy]

They're both difficult, but in different ways. As an EMT, you're more likely to be around burning buildings or cars, downed power lines, or in rough neighborhoods with street gang members trying to shoot you, while, as a physician, you're in a more controlled environment like the hospital or an air-conditioned office. But, as an EMT, providing the actual medical care is much more straightforward. Its just basic first aid and CPR. As a physician, your medical decision-making is much more complex and you do much more complicated procedures.

As an EMT, the most complicated treatment decision you generally have to make is the following:

1. Do I need to call paramedics?
2. Should I put this NRB on 15 L/m or 10 L/m?

 

[umean2tellme]

Out of curiosity... If there was a program in which 15 residents that were terminated in the past five years were all minority/female while graduating class has been 99.5% Caucasian... Would that intrigue anyone to look into it?

Is this a true story?

 

[michaelrack]

Out of curiosity... If there was a program in which 15 residents that were terminated in the past five years were all minority/female while graduating class has been 99.5% Caucasian... Would that intrigue anyone to look into it?

That would only be intriguing if the terminated minorities were American graduates.

 

[metabolite]

Is this a true story?

Yes, and this is true. There are at least one resident who decided to leave on his own, who is also a foreign born AMG. All these dismissed residents are minority AMGs.

Other programs in the same place also have history of terminating minority residents only, though numbers I cannot verify.

 

[Top Gun]

As an EMT, the most complicated treatment decision you generally have to make is the following:

1. Do I need to call paramedics?
2. Should I put this NRB on 15 L/m or 10 L/m?

Yes, I agree. And I clearly stated that medical care provided by an EMT is much more straightforward that that provided by a physician. I didn't say that EMTs make complex medical decisions like physicians do. I did say, however, that physicians generally don't have to work in hazardous conditions like EMTs often do. So you could argue that both jobs are difficult, but in different ways. Read my post again.

 

[survivordo]

What are the qualities of an excellent intern? I think that's what would be most important for us to know. Are these qualities general or field-specific? What are things that you do not expect of the intern that you do expect of the attending (just so we're clear that this is a training position and not a finished product)?

And what is meant by "lazy intern"? Is this someone who isn't at the appropriate knowledge base? Doesn't call/follow up consults on time? Doesn't complete progress notes/DC summaries in a timely manner? Misses important problems in the patient? Or are we talking about something else here?

The most important quality an intern can possess i s the ability to determine when they need to get help and when it is a situation they can handle on their own. This is a moving target as your skill level increases throughout the year and residency. Combine this with a good work ethic and you will be fine.

I am surprised to see how many of my colleagues actually LACK these qualities, there are a few that are just plain scary. Lazy, Lazy, Lazy.

Survivor DO

 

[Siggy]

Yes, I agree. And I clearly stated that medical care provided by an EMT is much more straightforward that that provided by a physician. I didn't say that EMTs make complex medical decisions like physicians do. I did say, however, that physicians generally don't have to work in hazardous conditions like EMTs often do. So you could argue that both jobs are difficult, but in different ways. Read my post again.

...except that most EMTs aren't working around downed powerlines or burning buildings either. Also working "around" as in "near" and "around" as in "I'm running into a burning building like a fire fighter" are two different completely situations. To extrapolate that and argue that it's what happens day in and day out would be like someone saying that physicians do the same by posting the picture of all of the Boston Athletic Association physicians running towards the marathon bombing victims.

 

[michaelrack]

Yes, and this is true. There are at least one resident who decided to leave on his own, who is also a foreign born AMG. All these dismissed residents are minority AMGs. .

I am intrigued.

 

[member0007]

Yes, and this is true. There are at least one resident who decided to leave on his own, who is also a foreign born AMG. All these dismissed residents are minority AMGs.

Other programs in the same place also have history of terminating minority residents only, though numbers I cannot verify.

What happened to the residents who were fired? They picked up another residency?

 

[metabolite]

What happened to the residents who were fired? They picked up another residency?

Found residency in different program
Searching for second chance in the same specialty
Bail out... To non clinical
Military.... GMO.

No resident union
No lawyers in the state to support them

 

[Nguy0727]

Please help me with some advice!!!!
I was terminated in residency because the faculty thinks that I was not at my level of training. This program was notorious for getting rid of residents. In getting rid, I meant in 3 years, they terminated 7 residents. Most of the terminated residents were minority. One of my classmates also was force to resigned, fortunately for him, he found another residency with the PD only ask for the certificate of completion of PGY1, and he was accepted into a new program. No communication between PDs.

As for me, I found another program that was willing to take me, and asked for LOR, unfortunately, the former PD would not write one but instead he said that is per protocol that he speaks with the new PD. so I provided the Pd phone number, I don't know what the pd said that the program change their mind and withraw the offer.

Now, I am applying for another program, and PD wants to contact the former PD. what can I do to prevent this from happening to me again?

All the faculty that knew me well is now not working there anymore. The only faculty that is left are the 3 directors. The rest of the faculty has been replace with new ones according to the website.

Please advise.
Thank you for taking the time to read my msg.

 

[metabolite]

Please help me with some advice!!!!
I was terminated in residency because the faculty thinks that I was not at my level of training. This program was notorious for getting rid of residents. In getting rid, I meant in 3 years, they terminated 7 residents. Most of the terminated residents were minority. One of my classmates also was force to resigned, fortunately for him, he found another residency with the PD only ask for the certificate of completion of PGY1, and he was accepted into a new program. No communication between PDs.

As for me, I found another program that was willing to take me, and asked for LOR, unfortunately, the former PD would not write one but instead he said that is per protocol that he speaks with the new PD. so I provided the Pd phone number, I don't know what the pd said that the program change their mind and withraw the offer.

Now, I am applying for another program, and PD wants to contact the former PD. what can I do to prevent this from happening to me again?

All the faculty that knew me well is now not working there anymore. The only faculty that is left are the 3 directors. The rest of the faculty has been replace with new ones according to the website.

Please advise.
Thank you for taking the time to read my msg.

Have you spoken to your current PD? Establish the level of entry in which your PD will help you out. He might support you for different specialty or even same specialty, but probably at a lower level (i.e repeating a year or two). Make peace with him and apply to the level that he will support you.

Because you did not get a contract renewal, unlikely that other PD will support you over the words of your previous PD. Sad but reality of residency...

This is what I think, if other members have different opinion please share...

 

[vistaril]

Please help me with some advice!!!!
I was terminated in residency because the faculty thinks that I was not at my level of training. This program was notorious for getting rid of residents. In getting rid, I meant in 3 years, they terminated 7 residents. Most of the terminated residents were minority. One of my classmates also was force to resigned, fortunately for him, he found another residency with the PD only ask for the certificate of completion of PGY1, and he was accepted into a new program. No communication between PDs.

As for me, I found another program that was willing to take me, and asked for LOR, unfortunately, the former PD would not write one but instead he said that is per protocol that he speaks with the new PD. so I provided the Pd phone number, I don't know what the pd said that the program change their mind and withraw the offer.
.

I'm always amazed at the lack of insight involved in some of these posts.....

here you have a situation where the resident was fired for poor performance by the pd. Then, they are seemingly surprised('I don't know what he said') when the pd of a new program calls the old pd(who fired resident for poor performance) and after the conversation the pd withdraws offer.

I mean think about the absurdity of that for a moment.....someone is calling your old PD who *fired* you because your performance was too inept to even remain on as a supervised resident. What do you think your old PD is going to say:

a) he's a great resident and I'm sure he will do well in your program
b) he's solid clinically, but unfortunately we had to let him go because ACGME rules dictate that we must fire at least 3 people per year so we just drew names out of a hat and he was unlucky enough to be picked
c) we had to terminate him because he was subpar to the point that he could endanger patient care if allowed to progress in the program. We tried to work with him but he just wasn't showing any progress. I could not recommend him as someone who is likely to succeed in residency

I mean really....think about it.

Now that doesn't mean terminated residents never catch on at another program and are given a second chance. Obviously some do. But I think the first step is to acknowledge that there were problems/own up to them, and have a plan to correct them if given a second chance.

 

[Nguy0727]

Other residents said I did fine, I pass my step3, compare with some one in the same program that did not pass their step. My in service exam was below averaged but that because I did not do it properly.. I explained that to them but they did not take it. There was two other residents who performed much worst in their in svc exam but their contract got renewed cuz their advisor said good things about them. Now that same advisor said good thing about me too cuz I did medicine with him but apparently that was not enough. That advisor is no longer there.
My offer was to repeat PGY1 again with the new program, and I don't mind repeating it, I am just concern that the pd will ruined my chance again. How can I avoid that from happening again?

 

[vistaril]

Other residents said I did fine, I pass my step3, compare with some one in the same program that did not pass their step. My in service exam was below averaged but that because I did not do it properly.. I explained that to them but they did not take it. There was two other residents who performed much worst in their in svc exam but their contract got renewed cuz their advisor said good things about them. Now that same advisor said good thing about me too cuz I did medicine with him but apparently that was not enough. That advisor is no longer there.
My offer was to repeat PGY1 again with the new program, and I don't mind repeating it, I am just concern that the pd will ruined my chance again. How can I avoid that from happening again?

I'm not fully sure I understand your question- how do you prevent your old pd from ruining your chances of getting into this new program, or how do you prevent the pd at your new program from disliking you as well? if it's the former, I don't see how you can. Any program you try to go to will almost certainly want to speak to the pd at the last program that fired you. or at least have some communucation.

But take a step back and look at the larger issue, which I'm still not sure you get. You mention you passed step3 and were below average on inservice exams. As if these are the reasons you were fired, or that they should have prevented you from being fired. That's part of your distortion right there. You got fired most likely because your day to day performance on wards and in rotation was so poor. You need to address that, and ask yourself why that was the case.

 

[Top Gun]

Other residents said I did fine, I pass my step3, compare with some one in the same program that did not pass their step. My in service exam was below averaged but that because I did not do it properly.. I explained that to them but they did not take it. There was two other residents who performed much worst in their in svc exam but their contract got renewed cuz their advisor said good things about them. Now that same advisor said good thing about me too cuz I did medicine with him but apparently that was not enough. That advisor is no longer there.
My offer was to repeat PGY1 again with the new program, and I don't mind repeating it, I am just concern that the pd will ruined my chance again. How can I avoid that from happening again?

I'm not sure what you mean when you say you didn't do your inservice exam properly. Do you mean you didn't study for it as much as you should have? Did you skip too many questions because you were running out of time? If so, that's not the program's fault. There are no excuses for poor performance on the inservice. Either you do well or you don't.

Also, have you looked at your evals? Do they show good or poor performance? If they were below-average, that was also a significant part of the reason for your termination. There must have been a reason for the program director to say you were not at the level you should have been. Other residents saying that you did fine means nothing. The evaluations from your attendings are the ones that count. And did you really expect the PD from the new residency not to contact your former PD? Of course they're going to contact him. Anytime a resident transfers to a new program, the new program is going to want to find out about any potential red flags.

I suggest you take a good look at any problems you had in your former residency before applying to a new one, and, if you do get into another residency, inform your new PD you have a game plan for addressing your deficiencies. And I would also talk to your former PD, and see if he can at least write you a satisfactory recommendation letter. I should warn you that it won't be glowing. At best, it will be lukewarm.

 

[kulley123]

I don't know if being a physician is "the hardest," but it's certainly much harder than being an EMT/paramedic. I was an EMT and worked on a rig for several years in college/med school.

This is simply ignorant.

How many 20+ year veteran paramedics do you know? All the ones I know have multiple physical injuries from carrying fat people for 20 years, make laughably little money, and have seen things that would make you want to kill yourself (not sarcastic at all). Compare that to a 20+ year attending; rich, no injuries incurred from working, complete with an arrogant and boorish attitude towards those they see as beneath them (i.e., everyone). Draw your own conclusions.

This isn't a debate and I won't be replying to any silly comebacks. But the opinions on this pathetic 'what I do is harder then what you do' conversation are true reflections of your character.

 

[smq123]

Let's stay on topic please. Thanks.

 

[45408]

This is simply ignorant.

How many 20+ year veteran paramedics do you know? All the ones I know have multiple physical injuries from carrying fat people for 20 years, make laughably little money, and have seen things that would make you want to kill yourself (not sarcastic at all). Compare that to a 20+ year attending; rich, no injuries incurred from working, complete with an arrogant and boorish attitude towards those they see as beneath them (i.e., everyone). Draw your own conclusions.

This isn't a debate and I won't be replying to any silly comebacks. But the opinions on this pathetic 'what I do is harder then what you do' conversation are true reflections of your character.

Silly comebacks? You mean "valid points that disprove what I was saying"? Because that's what I'm about to tell you. I know surgeons with back problems from standing for so long, more surgeons with carpal tunnel problems from operating, and even more who aren't rich because they have gigantic loans to pay off.

Paramedics don't make much money, agreed. I do know several 20+ year veterans, but I don't ask them their medical problems. You act like you're above this by implication but then say "draw your own conclusions." Not so fast.

 

[Arcan57]

This is simply ignorant.

How many 20+ year veteran paramedics do you know? All the ones I know have multiple physical injuries from carrying fat people for 20 years, make laughably little money, and have seen things that would make you want to kill yourself (not sarcastic at all). Compare that to a 20+ year attending; rich, no injuries incurred from working, complete with an arrogant and boorish attitude towards those they see as beneath them (i.e., everyone). Draw your own conclusions.

This isn't a debate and I won't be replying to any silly comebacks. But the opinions on this pathetic 'what I do is harder then what you do' conversation are true reflections of your character.

You clearly have issues that a discussion on a bulletin board forum are not going to clear up. That is all.

 

[IlDestriero]

Digging ditches and farm labor is hard work, but I think medical school and being a physician is harder. $ociety seems to agree.

 

[Siggy]

This is simply ignorant.

Were you looking in the mirror when you wrote this post? That's the only way this line makes any sense to me.

How many 20+ year veteran paramedics do you know?

Paramedics with 20 years experience are vastly outnumbered by paramedics with 1 year experience repeated 19 times.

All the ones I know have multiple physical injuries from carrying fat people for 20 years,

There are tons of physical jobs that result in more injury. The bigger problem with EMS is that EMTs and paramedics often don't want to use the resources and skills (body mechanics) available to them.

make laughably little money,

Well, 1000 hours of training after high school is a laughable amount of education and cook book protocols are a laughable amount of responsibility. However I can point you to a thread on a Facebook EMS group full of EMTs and paramedics who are too afraid to do something as simple as NEXUS or Canadian C-Spine in order to not backboard every patient. Why? Thinking is hard and comes with liability.

and have seen things that would make you want to kill yourself (not sarcastic at all).

Are you the person providing the Scripps National Spelling Bee with their example sentence for the word "hyperbole?"

Compare that to a 20+ year attending; rich, no injuries incurred from working, complete with an arrogant and boorish attitude towards those they see as beneath them (i.e., everyone).

I didn't realize that recognizing faults and limitations is now "arrogant and boorish." Do your farts also smell like candy canes and rainbows?

This isn't a debate and I won't be replying to any silly comebacks. But the opinions on this pathetic 'what I do is harder then what you do' conversation are true reflections of your character.

 

[metabolite]

Let's stay on topic please. Thanks.

Ditto.

I appreciate kully's sympathy on his initial post, but comparing medical school/residency to EMT/paramedic training is a gross underestimation... almost offensive actually. If you think paramedics are equal to doctors, I don't think you are in a medical field at all.

On that note... Being terminated during residency is infinitely more painful and financially serious than getting kicked out of an emt training. Usually there is another door waiting, but it is definitely hell in the hallway.

 

[metabolite]

As was noted, a surprising number of them are spectacularly lacking in insight. Though I'm not counting out problems with the system either.

... And sometimes just choosing a wrong field or wrong hospital. I know several people who ended up switching specialty late in their residency and still come out fine in the end... But clearly it remains a painful memory for each one of them, even now.

 

[Hamachi]

Please help me with some advice!!!!
I was terminated in residency because the faculty thinks that I was not at my level of training. This program was notorious for getting rid of residents. In getting rid, I meant in 3 years, they terminated 7 residents. Most of the terminated residents were minority. One of my classmates also was force to resigned,

How is "forced to resign" any different from "terminated" or "contract not renewed" or "decided not to promote" or "resigned in lieu of dismissal"?

Does it make any difference when reapplying? Or for licensing?

What if a suit is brought against a program who "terminated" and a settlement is made so that "resignation" is mutual agreement. Will the program still indicate a resident was terminated to anyone who inquires? Will the PD tell the next PD that they got sued?

 

[DrT2202]

Absolutely positively wrong. This "permanent record" will contain things that will astonish you and can and will be used against you should you find yourself on the wrong side of the street. For example, an innocent comment in the resident's lounge, or perhaps a slightly off color joke gets noted and is placed in the "permanent record." You have a bad day and irritate an attending, who complains to the PD. The off color joke and your crankiness get you an RSVP to the PD who comments that you seem tohave a problem with professionalism and evidence of this is pulled out and placed on the table for you to respond to. Never mind there are a hundred positive things in the file. You are in VDS. Make no mistake about it, in residency, anything you say, do not say, think or do not think can and will be taken down in evidence and used against you should the powers that be decide it should be so.

Tread lightly my friend, grow eyes in the back of your head and stay off the radar.

This is so enlightening. I wish I read that before. I was very liberal with what I say in my residency and now I have a problem and asked to resign. I never thought I couldn't be a free human and express opinions/views if they don't hurt the patients. Should've shut my mouth many times 🙁

 

[Innocent resident]

Hey, I know this forum is about being fired. I'm not at that point, but I think that I certainly need to have that issue in the back of my mind given my circumstances...

In writing this I thought about keeping it short and simple. But because I am seeking advice, I tried to pack as much info into this as possible...

Here's my situation,

STORY
Halfway through my intern year I rotated with a faculty member, Dr. J, who felt that I would benefit from an additional X months of wards. I, too, felt that I was weak in my ward skills and agreed. These ward months would mean an extension of intern year and hence my residency.

Since then I started to work harder, read more, and work on the problems outlined by Dr. J. However, as the beginning of my extension period neared, I was approached by a senior resident who was adamant that I should not have been retained. His argument was that there were others in the program that were weaker than me. He also felt that I was much a stronger intern than he, himself, was at that point in his residency. In fact a few years earlier he was also asked to be retained, but instead he went to the Chief of the department, the PD and anyone else who would listen to him. The program yielded to his demands and he moved on with the rest of his class as R2. He was successful since then. With that said he urged me to refuse being retained and to move onward.

I thought carefully about what he said. Up until that point I had not really compared myself with anyone else in the program. After all, I was too busy trying to improve myself. A few days later one of my friends in the program, a fellow intern, told me that he knew 100% that my medical knowledge was far greater than his and he remained baffled as to why I had let myself be retained. Along with another friend, it was suggested that one reason that I was retained was because I had not networked efficiently enough - as compared to others in my intern class such as my friend.

With all of the above said, I was galvanized and decided to take the advice of the senior resident mentioned in paragraph 2. Unfortunately for me, the PD that the senior was replaced by is not my current PD "less cool". Either way, things worked out for me some what. The program put forward a new stipulation. I am to do X ward months back to back during which I will get evaluations from faculty attendings. At the end of the X months a committee made up of these attendings will meet and evaluate my performance. If I am ready to go on to be an R2 then the X extra months will count as a part of my second year (hence, I graduate on time with the rest of my class). If, however, my performance is not satisfactory then I am to repeat my intern year. Because I felt confident in my ability, I agreed to the stipulation.

Since then, my X number of ward months has begun. I've already rotated with Dr. J who, albeit reluctantly, agreed that I should progress to an R2 - under close supervision. According to him, I am doing what an R2 should be doing. Interestingly, he said that he didn't want me to feel singled out; or to feel that the program is out to get me. He also mentioned that I am not the only one retained and that there are others in my class who should have been retained but who did not rotate with him, and therefore he could not retain them. (geez thanx for telling me that 🙁). Finally he mentioned that medical knowledge wise I was in the top third of my class, but as a decision maker was in the bottom third. (ok...so I'll work harder!)

However, I ran into difficulty into one of my later ward months. This rotation is with Dr. K. His evaluation bashed the hell out of me in everyway 😱. My medical knowledge is at the level of an intern at best. He also got me on tons of others stuff. Personally, I felt that if I made the same mistake as my senior then I was chastised much more caustically than my senior. In fact there were one or two instances where I got blamed for my seniors mistakes.

SUBJECTIVE THOUGHTS
1. I'm know I'm not God's gift to residency programs. But I also know that I'm not Satan's poison. I do make small mistakes, especially when the team is rounding fast and I may forget to correct an electrolyte abnormality...But I don't feel that I need to repeat my intern year.

2. I honestly feel like I'm under the microscope. It seems that if I make the same mistake that others at my level of experience make, I will be chastised more harshly than my colleague(s). Furthmore, if I make a great decision or diagnoses, nobody gives my any credit...i.e getting a diagnosis and treatment right despite the fact that the attending and/or specialty fellow were on the wrong track. This has happened a few times...

3. Acquaintances in my program look at me differently and feel awkward around me. While I like this program and would gladly continue on here, I do feel that I am "marked" at this program. I am concerned that it's only going to miserable given that faculty who did think highly of me think less and maybe even lesser as time goes on.

4. My evaluations...initially there were average for wards and super for consult months. Since my retention they are all waning. The one by Dr. K made me seem like a ******. I am concerned about my future in this field.

THINGS I WOULD HELP WITH IN DECIDING/DOING
1. Do you have any suggestions?2. Obviously, I've become progressively despondent and withdrawn from my class. Has anyone else in this forum had a similar experience to me? How did it feel? How did you deal with this situation? How do you get over the fact that others may view you as inferior? Are there ideas on how to cope with this? In your case...or in the case of others who are/were in the same situation, what was the final out come?

3. How will retention affect my chances of getting a job after residency? How will it affect my chances of fellowship, should I decide to pursue fellowship?

4. Because I am beginning to feel "marked" it seems that continuing here may prove futile...Has anyone ever transferred out of such a program? What are my options?

5. What about transferring to another specialty? How should I do this? I am obviously concerned that if I apply to another specialty, then once my PD comes to learn about this, he/she will terminate contract. Can you give me any tips on how to proceed with this area?

I would appreciate any good advice.

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

 

[rokshana]

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

dude, if a hospitalist is complaining about you, then you are doing something...hospitalists (non teaching ones anyway) don't give a $h!t about residents enough to go and complain about them.

and didn't you post that you had a terrible ITE? That is a bit objective don't you think?

 

[LucidSplash]

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

And you are replying to a >4 year old post

 

[Innocent resident]

dude, if a hospitalist is complaining about you, then you are doing something...hospitalists (non teaching ones anyway) don't give a $h!t about residents enough to go and complain about them.

and didn't you post that you had a terrible ITE? That is a bit objective don't you think?

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

 

[Innocent resident]

And you are replying to a >4 year old post

Yes

 

[LucidSplash]

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

Sometimes yes, a program will remediate a resident for this, especially if there are other perceived issues or more than one poor ITE performance.