The program is on probation

[CTS]

What does it mean? What are the consequences? Can I ask about probation during interview?

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[Winged Scapula]

What does it mean? What are the consequences? Can I ask about probation during interview?

Programs can be put on probation for a variety of things - some pretty stupid like programs not turning in required paperwork (ie, things that don't necessarily affect you as a resident) to work hour violations, residents not logging cases, not having enough operative time, etc. See ACGME for details about programs being put on probation.

Almost all programs put on probation rectify the problems and go on to get at least provisional approval, if not full.

If a program is on probation when you interview there, you should definitely ask about it. MY residency program was on probation and the PD brought it up before all the candidates, so they knew we weren't trying to hide it and understood that it meant some people would not rank us. I think programs are required to tell interviewees if they are on probation. If the program doesn't bring it up, I would worry and certainly ask about it.

 

[doc02]

MY residency program was on probation and the PD brought it up before all the candidates, so they knew we weren't trying to hide it and understood that it meant some people would not rank us.

Um, that's called damage control, lol. The status of a program is known, it's not like you can't find out anyways. Of course you're going to spin it into "look at how open and honest I am."

 

[Winged Scapula]

Um, that's called damage control, lol. The status of a program is known, it's not like you can't find out anyways. Of course you're going to spin it into "look at how open and honest I am."

Of course its damage control. But there have been reports of programs on probation that didn't reveal it to candidates. And believe it or not, there are a lot of applicants that don't bother checking these things out before they apply.

 

[doc02]

There's no real point to checking. Residency is B.S. and I'll explain why. Everything from this point on in this post is a hypothetical and completely made-up to demonstrate a point. Let's say you heard that Stanford was on probation. What are the odds that Stanford will permanently lose accredidation as a training program? You want to take that bet? OK, so now we've established that Stanford will not lose accredidation. Now, ask yourself if you're a candidate, do you care that Stanford is on probation? Probably not. You'd be happy to go to "on probation Stanford." OK, so how about small community programs? Well, either you WANT to be community trained and are a good candidate, in which case you'd be shooting for the better community programs, which also will probably not lose accredidation, or you're not a good candidate and are being forced to apply to community programs as a safety. In which case, you really can't turn your nose up at a program for being on probation. By the way, this is a genuine question that I don't know the answer to: how many programs have actually lost accredidation ever? Probably not many.

 

[Pilot Doc]

There's no real point to checking.

By the way, this is a genuine question that I don't know the answer to: how many programs have actually lost accredidation ever? Probably not many.

I agree with the logic of your arguments, but not your conclusion. Would a program being on probation completely scratch them from your rank list? No. Would you equally rank Man's Greatest Hospital and Best Medical School if BMS was on probation? No, the edge goes to MGH. So the information is useful.

As to programs that have been permanently shuttered, the only one I recall lately is Charles Drew in Los Angeles. That left a bunch of residents scrambling to find new programs. Lots of small community programs have been merged into larger (typically univ) programs, perhaps under threat of closure, but the residents never got kicked onto the street in those cases.

In terms of the overall picture of bad things that can happen to you between age 26 and 31, permanent residency closure is a very small risk, I agree.

 

[Winged Scapula]

That was my point in checking for programs on probation. While it might not change whether or not you rank the program, it might certainly change where you rank them on your list. The chances of a program actually closing are pretty rare, as noted in my earlier post. I personally would be interested in why a program is on probation...if its for things like residents not turning in case logs, then I don't really care...it doesn't tell me much about the program. If its for hours violations then I might pay more attention.

 

[doc02]

Would you equally rank Man's Greatest Hospital and Best Medical School if BMS was on probation? No, the edge goes to MGH.

I doubt that anyone has any two programs exactly equal and is waiting on probationary status to be the tiebreaker on ranking. But if I had to chose between the two, I'd pull up the pictures of the current residents and see which one had hotter females. Then again, with those two hospitals, you'd probably start drinking methanol if faced with that proposition.

If its for hours violations then I might pay more attention.

If you care so much about hours violations BEFORE the Match, then you should care about them equally AFTER the Match. I mean, if you were a man and made sense.

 

[Castro Viejo]

Ithink another program that recently shut down is Graduate Hospital in Philadelphia. I think this had something to do with their board pass rate. That kind of thing would be a bigger red flag to me than case logs or duty hours violations.

 

[doc02]

Absolutely. I googled and it looks like the entire hospital was closed, however. But even though it makes sense, does anyone know if Board pass rates actually lead to loss of accredidation? I mean, Graduate had the lowest pass rates that I saw on a passing glance, but there were a number of university programs that have pass rates in the 40-50% range, which isn't that hot if you ask me. Or are those numbers made up? Because I can't believe that there are small, unknown community programs that have better pass rates than university programs. Like, if one person at a community program fails, you've basically tanked your program.

 

[smq123]

Ithink another program that recently shut down is Graduate Hospital in Philadelphia. I think this had something to do with their board pass rate. That kind of thing would be a bigger red flag to me than case logs or duty hours violations.

I thought that it was due to the fact that Tenet sold Graduate Hospital to Penn. Penn had decided to turn the entire building into a rehab center. It didn't seem like it had anything to do with pass rates or hour violations.

http://www.uphs.upenn.edu/news/News_Releases/jan07/graduate-hospital-purchase.htm

 

[ELpotop]

I thought that it was due to the fact that Tenet sold Graduate Hospital to Penn. Penn had decided to turn the entire building into a rehab center. It didn't seem like it had anything to do with pass rates or hour violations.

http://www.uphs.upenn.edu/news/News_Releases/jan07/graduate-hospital-purchase.htm

A Graduate Hospital has 25% combined written and oral passage rate over the past 5 years (2002 – 2007); which ranks the program at the bottom of 248 surgical programs in the country. This is why it has shot down.

Take a look below at the American Board of Surgery score report of all the programs in the country for the past five years.

https://home.absurgery.org/xfer/fyp2007summary.pdf

 

[Dr. V]

Remember there are other things that impact the pass rates as well.

We have a couple that did fellowships and didn't sit for their boards, that hurts the numbers as well. One guy went into plastics, obviously he was very good at boards etc. All three of his fellow graduates passed, but his class has a 75% pass rate because he never took the exam.


That kind of stuff is easily explained and proven, but if you just look at the numbers it can be misleading.

 

[smq123]

A Graduate Hospital has 25% combined written and oral passage rate over the past 5 years (2002 – 2007); which ranks the program at the bottom of 248 surgical programs in the country. This is why it has shot down.

Take a look below at the American Board of Surgery score report of all the programs in the country for the past five years.

https://home.absurgery.org/xfer/fyp2007summary.pdf

Looking at the ACGME, it seems more like ALL residency programs at Graduate were shutting down, though.

acgme.org/acWebsite/resReview/resR_news07_07.pdf

It may not have been a very good program, but I don't think that it was shut down because of its deficiencies.

 

[doc02]

One guy went into plastics, obviously he was very good at boards etc. All three of his fellow graduates passed, but his class has a 75% pass rate because he never took the exam.

I call B.S. If people who went into fellowships counted against pass rates, then university programs would have like 10% pass rates universally.

 

[Dr. V]

I call B.S. If people who went into fellowships counted against pass rates, then university programs would have like 10% pass rates universally.

Well you would be wrong.

Sorry but pass rates are the bottom line, number of graduates that pass divided by number of total graduates no matter if they ever sit for the exam or not. That's a fact. If they don't take the boards for any reason, they just don't want to, they go on a mission trip to another country, they go into plastics and decide to only take the plastics boards, they count against the program. There are no excuses, either your graduates passed or they didn't. I know for sure that's how that works. The guy that went into plastics COULD have taken the boards, but he didn't and it took a 100% pass rate down to 75%. I have no doubt he would have passed if he had taken it but that didn't matter, the pass rate was 75% becasue he never sat for the boards.

What I am unsure about is if one fails the first time and passes a year later, or if after his plastics fellowship he decides to take his boards then what happens? Are those numbers then revised? I don't know about that.

I do know you don't get a break if your resident does a fellowship and doesn't take the boards, that's just tough and it counts against the program.

 

[Pilot Doc]

I call B.S. If people who went into fellowships counted against pass rates, then university programs would have like 10% pass rates universally.

Oh grasshopper. Try to understand before you attack.

The issue is not who pursues fellowships. The question is who takes the GS boards. In the relatively recent past, GS board certification was a pre-req for every subspecialty board. That is eroding - plastics, cardiac, (?) vascular have all dropped the requirement. These people can solely take their subspecialty boards. People who do fellowships in breast, transplant, lap, surg onc, trauma, etc still take the GS boards.

 

[doc02]

OK, then when these people hypothetically DO take the Boards in other years, I guess the pass rate for that year suddenly becomes 160%?

 

[Pilot Doc]

OK, then when these people hypothetically DO take the Boards in other years, I guess the pass rate for that year suddenly becomes 160%?

The pass rate is for general surgery boards. People who take plastics, thoracic, anesthesiology, etc. boards don't count.

 

[doc02]

The pass rate is for general surgery boards. People who take plastics, thoracic, anesthesiology, etc. boards don't count.

Right, but Anesthesia wouldn't count because they're just prelims and neither would Plastics because they also either drop out after PGY-3 (combined) or are never part of you (dedicated). And most everyone else has to take General boards. Therefore, if they count as "not qualifying" one year, then they most definitely count as "qualifying" when they take it. You would have 20/5 qualifying or something.

Believe me, I'm not a master of any of this stuff, but I'm pretty sure the Board pass rates actually make sense. They definitely don't have it formulated where if you don't ATTEMPT it one year, you count as a FAIL and then never make it back into the pool of number when you DO attempt it. What's the point of publishing the pass rates if programs are basically all failing because their fellowship candidates are basically hitting them in the ass? (Plus, it's probably a moot point because every fellow I've know has taken their Boards on cycle.)

Bottom line is that this is just a **** line fed to people to explain poor pass rates. It's a lie. Programs don't like having low scores any more than applicants do. The only difference is they make up a load of **** and people will eat it up. If I made up the same load of **** to explain my scores to them, they'd be like, "uh, yeah right, take a hike."

 

[Pilot Doc]

The pass rate is for general surgery boards. People who take plastics, thoracic, anesthesiology, etc. boards don't count.

From the ABS
Once an application is approved, the applicant has a maximum of five opportunities within a five-year period to pass the QE. If an applicant decides not to take the exam in a given year, it is a lost opportunity as the five-year limit is absolute.

So after five years, the board pass rate is set. If you haven't taken it in those 5 years, you fall into the not pass category. And the stats are for each graduating class.

As for plastics, thoracic, anesthesiology, I was talking about people who finish a general surgery residency, are eligible to take the boards and then don't. There are a substantial and increasing number of GS grads who don't have any reason to take the GS boards.

As for why publish if fellowship candidates skew the numbers, that's going to be a bigger and bigger issue as fast-tracking comes on line. I suspect the ABS will adjust the stats somehow. For now, we have a system designed for a time when no one could practice without taking the boards. Times have changed and the published pass rates are less informative than they once were.

And watch your mouth.

 

[Dr. V]

Right, but Anesthesia wouldn't count because they're just prelims and neither would Plastics because they also either drop out after PGY-3 (combined) or are never part of you (dedicated). And most everyone else has to take General boards. Therefore, if they count as "not qualifying" one year, then they most definitely count as "qualifying" when they take it. You would have 20/5 qualifying or something.

Believe me, I'm not a master of any of this stuff, but I'm pretty sure the Board pass rates actually make sense. They definitely don't have it formulated where if you don't ATTEMPT it one year, you count as a FAIL and then never make it back into the pool of number when you DO attempt it. What's the point of publishing the pass rates if programs are basically all failing because their fellowship candidates are basically hitting them in the ass? (Plus, it's probably a moot point because every fellow I've know has taken their Boards on cycle.)

Bottom line is that this is just a **** line fed to people to explain poor pass rates. It's a lie. Programs don't like having low scores any more than applicants do. The only difference is they make up a load of **** and people will eat it up. If I made up the same load of **** to explain my scores to them, they'd be like, "uh, yeah right, take a hike."

doc02, no you are the one that is FOS because you don't know what you are talking about and are just talking out your @$$ on this one while making incorrect assumptions.

The guy I am talking about was my Chief Resident as a 3rd year in medical school. He went into Plastics and completed that, passed his plastics boards, but the pass rate for his class is still only 75%. I personally know that every chief in that year except him is board certified in GS, and he was 1 of 4 graduates that year.

As I said before, I didn't know what would happen if he decided to take his boards, but evidently Pilot Doc has shown us that if he takes them within 5 years of graduating then the pass rate would go up to 100% for that year. So he has one more year or that class pass rate will be forever 75% even though the one that didn't "pass" his GS boards never sat for them and is boarded in Plastic surgery. He won't take the GS boards, why would he? He's doing what he wants to do without it.

Pilot, thanks for that link, now I know that they have 5 years.

 

[doc02]

Hey, if Plastics counted, then lots of major institutions would be getting slammed each and every year (well, fewer now that most Plastics programs are moving away from the combined program format). I guess if people leave the program, too, they count as "not qualified"? I mean, if the ABS is counting designated prelims against your program, I'm pretty sure they're counting categoricals who leave. Your PD sure has you buying whatever he's selling.

 

[doc02]

Oh, and let me clarify what I mean: this whole discussion has basically turned into a cover for why some university programs score lower than some community programs. You can just go, "oh, uh, well, actually we have 100% pass rates, but it shows up as 44% because of all of our fellowship-bound residents." Same thing when people question why a program is on probation. I actually did this once and I got some mumbo jumbo about how it was "just some administrative stuff, nothing to worry about." Oh, OK! Hey, how about we all be that vague when we APPLY to your program?

 

[Dr. V]

Hey, if Plastics counted, then lots of major institutions would be getting slammed each and every year (well, fewer now that most Plastics programs are moving away from the combined program format). I guess if people leave the program, too, they count as "not qualified"? I mean, if the ABS is counting designated prelims against your program, I'm pretty sure they're counting categoricals who leave. Your PD sure has you buying whatever he's selling.

Do you have problems with reading comprehension or something? They didn't count a prelim, he was my CHIEF RESIDENT when I was a 3rd year, he friggin graduated the program board eligible for GS and totally rocked the ABSITE (obviously or he would have never gotten plastics).

He did a plastics fellowship and has never taken the boards so that class has a 75% pass rate.

The other 3 are all attendings at teaching institutions, one is currently in the Army on deployment, one is an attending here and the other is an attending at Cornel (I think, it's one of the ivys that she got, didn't know her as well). All three of those are board certified in GS, the only one that isn't is the Plastics guy, and he's boarded in plastics but not GS. That doesn't help though and the pass rate is still 75% unless he decides for some reason to take the boards.

 

[doc02]

Thanks, but you don't get what I'm saying. You know how many people go through regular General Surgery and then go PRS? Most Plastics people in a General Surgery program are designated prelims. Look at the board pass rates and you'll see a number of university programs with pass rates in the 40-50% range. And you want me to buy that the reason is because all the fellows are neglecting to take their Boards at those particular places? LOL.

 

[doc02]

.

 

[Dr. V]

No, I didn't want you to buy anything. I was only putting information out there because this is a relatively new thing that is happening and some people may like to know that the numbers can be a little misleading at times.

I also stated that IF someone gave you that reason it would be very easy to verify. However we are at 80%, not great but not down in the "explain" range either and we have never explained our pass rate to anyone that I am aware of (of course I have only been involved in the interview process for 3 years so it likely has happened I guess).

I will be the first to admit that 80% isn't good enough and we should improve, not saying that at all. I am at ETSU in case you are wondering, it's in my profile etc. I'm not an anonymous person. Yes it would help our numbers alot if he would just take the dang test, but he has no reason to. If he took it, and with Doctor X that just came back to the US from Equador and passed our rate would shoot up to 90%, that looks much better than 80 LOL but really it makes no difference. We are the same program either way (I am glad to learn that Doctor X is now going to count for us instead of against us since he came back).

I was saying that now the numbers aren't as accurate as they used to be and it is something for people to be aware of.

And actually I would think it would have more of an impact on small community programs because if you only have 2 residents a year graduate and one of them did you that way you would automatically be at a 50% pass rate.

 

[doc02]

Whatever, dude. I'm not trying to make this into a "my place is better than yours" debate. My personal pet peeve is how into name recognition every is, personally. As for Board scores, my place has extremely HIGH scores and yet some of the stuff even my Chiefs tell me have me wondering what they were smoking because they are directly antithetical to things that are easily found in textbooks. And these aren't small things, either. All I know is that Board scores are scores and IF you care about them they're there for a reason. I know they're there, I don't care much at all so long as I pass.

 

[Dr. V]

I surely never meant that cause 80% ain't anywhere near one of the "better" board scores. Hell it's the lowest in the state of Tennessee. I don't know why you would think I thought our scores were good or something.

Adequate yes, they are high enough to show that if you come here and apply yourself you will be fine, but there is plenty of room for improvement. There are lots of programs out there that are 100% or dang close to it (New Hanover is 100% and several others).

It was honestly just started out as one little addition of information for someone to think about with the way things are changing in the surgery landscape.

 

[Pilot Doc]

but it shows up as 44% because of all of our fellowship-bound residents."

You have to pay a little more attention to the details.

Some fellowships (e.g. PRS, thoracic) lead to board eligibility in a specialty that DOES NOT REQUIRE GS board certification. This lowers a programs board pass rate.

Any fellowship that does not lead to subspecialty board eligibility (breast, surg onc, endocrine, txplant, pure trauma, HPB, etc.) will still require GS boards. Some fellowships that do have a board (peds, ?colorectal) still require GS board certification

So this is not an excuse for low pass rates except in the circumstance that a program sends lots of people into specialties that don't require GS boards. It may become an issue for cardiac heavy programs, for instance.

And the only people who count are graduating chief residents. Prelims, people who quit, intergrated plastics, etc, don't count.

 

[Winged Scapula]

If you care so much about hours violations BEFORE the Match, then you should care about them equally AFTER the Match. I mean, if you were a man and made sense.

Who said I didn't care about work hour violations?

It may seem nonsensical to you and others, but my problem is two-fold:

1) I don't want residents to violate work hours but at the same time I don't think we need to be creating a workforce of clock watchers. If there is work to do, stay and do it without pawning it off on someone else.

2) So, it appears that sometimes it is necessary to violate work hours. I get angry though at programs that give lip service to adhereing to the regulations but either ignore it when violations happen, refuse to do anything to correct it, or blame the residents when it happens.

I'm not sure how this is evidence that I don't care about work hour violations after the match.

 

[Winged Scapula]

Or worse, out and out require you to violate hours based on daily rounding schedule and call structure. That galls me the most, and I've only been around for what, like four months. Ridiculous.

So true. When they can't even find a way to pretend like they care about the work hours, its pretty galling.