This sucks! Six month extension...

[zzzzzz]

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I was supposed to be coming to the close of my intern year, but I had a meeting with the director yesterday in which he sprang upon me that they would be offering me a 6 month extension on my intern year, so that if all goes well I would be a 2nd year in January 2008. What led to this was that I had failed a rotation earlier in the year, but was told that I could repeat it as a second year elective and it would not be counted against me / wouldn't add an extra month to my residency. Then I took a 4 week leave of absence later in the year due to problems at home (my husband I separated, trying to take care of a 2 yr old and a 1 yr old, and dealing with major depressive disorder). So this is my first week back and now this. I guess looking at it from their perspective I probably don't appear to be the most stable resident, but I didn't think I sucked this bad. I know I shouldn't be, but I am so humiliated to still be called a first year and have to attend all the intern meetings. If I could quit, I would. So what do I do now? This royally sucks and I don't want to be here.

 

[Faebinder]

Take it and be happy he didnt just fail you and drop you. Stay the course. If you wish to switch to a different residency program (which is wise thing to do in the future) do so AFTER you finish your first year in january 2008. Otherwise you will be jeapordizing your career.

My two cents.

 

[SoCuteMD]

I was supposed to be coming to the close of my intern year, but I had a meeting with the director yesterday in which he sprang upon me that they would be offering me a 6 month extension on my intern year, so that if all goes well I would be a 2nd year in January 2008. What led to this was that I had failed a rotation earlier in the year, but was told that I could repeat it as a second year elective and it would not be counted against me / wouldn't add an extra month to my residency. Then I took a 4 week leave of absence later in the year due to problems at home (my husband I separated, trying to take care of a 2 yr old and a 1 yr old, and dealing with major depressive disorder). So this is my first week back and now this. I guess looking at it from their perspective I probably don't appear to be the most stable resident, but I didn't think I sucked this bad. I know I shouldn't be, but I am so humiliated to still be called a first year and have to attend all the intern meetings. If I could quit, I would. So what do I do now? This royally sucks and I don't want to be here.

HOnestly, I hate to sound insensitive. I really can relate to some of what you are saying. From an outsider's perspective, though, you are lucky. You failed a rotation and it wasn't going to count against you. You then took a month-long leave of absence. Having not (satisfactorily) completed 2 month's worth of your first 12 of residency, you are lucky that you were offered an extension. Yes, an extra 6 months of residency sucks, but if your PD decided to be an @$$ right now he probably could have justified terminating you and jeopardized your career.

I'm really sorry about your marriage and depression, I know that must be incredibly difficult.

 

[NotAProgDirector]

I was supposed to be coming to the close of my intern year, but I had a meeting with the director yesterday in which he sprang upon me that they would be offering me a 6 month extension on my intern year, so that if all goes well I would be a 2nd year in January 2008. What led to this was that I had failed a rotation earlier in the year, but was told that I could repeat it as a second year elective and it would not be counted against me / wouldn't add an extra month to my residency. Then I took a 4 week leave of absence later in the year due to problems at home (my husband I separated, trying to take care of a 2 yr old and a 1 yr old, and dealing with major depressive disorder). So this is my first week back and now this. I guess looking at it from their perspective I probably don't appear to be the most stable resident, but I didn't think I sucked this bad. I know I shouldn't be, but I am so humiliated to still be called a first year and have to attend all the intern meetings. If I could quit, I would. So what do I do now? This royally sucks and I don't want to be here.

Let's be 100% clear about a few things:

1. After failing a rotation, your residency was guaranteed to be extended by one month. The boards are very clear about this -- you need XX months (36 for IM, my field) of satisfactory training. Making a month up leaves you a month short no matter how you slice it and dice it (unless you sacrifice some of your vacation, which most RRC's do not allow you to do). Once you take the LOA, you are now 2 months behind -- so extending by 6 months is really only an extra 4 months.

More importantly:

2. Your training is being extended by 6 months because your performance at this time is not at the level of a PGY-2. In 6 months, one of three things will happen: 1) you will be promoted to a PGY-2, 2) your PGY-1 training will be extended further, or 3) you will be terminated. Simply showing up for the next 6 months will not make you into a PGY-2.

I say this not to be mean, and not to kick you when you are down. I know you must feel like crap, and it's unclear from your prior post whether the MDD was yours or another family member's. Regardless, you need to try to buckle down and get the work done, or you may find yourself without a slot at all.

Perhaps you need a longer LOA to address your mental health issues or your personal issues? You need to be your best in the next 6 months.

 

[elwademd]

try to look at the bright side- your program is continuing to work with you in/and your situation. it's unfortunate that you've had to go through the things you have, as well as continuing to be an intern... but in the end, you continue to be there.

Once you take the LOA, you are now 2 months behind -- so extending by 6 months is really only an extra 4 months.

well said.

it definitely must be hard to go through this, but the opportunity to continue with your program is far better than the alternatives, especially at this time of the year.

 

[IFNgamma]

what do you mean fail a rotation? I didn't know there's a pass/fail system for rotations as a resident. Does "failing" it mean that your evaluation by the attending was so bad that he/she thinks you were totally incompetent?

 

[zzzzzz]

Wow! Thanks for your replies. It really helps to put things in perspective. I am feeling so sorry for myself, but I guess all things considered I am pretty lucky. (Trying to convince myself....) But I know what you mean, it might be easier to dump me.

Although, looking at it from a PD's perspective, it is really not a good thing to lose residents. Not only does it bring down morale for the program, but when it comes time for renewal of the program, the PD has to explain the lower matriculation rate. It also screws up call schedules. But this is an aside.

In my case, my failed rotation was a weird situation. I had 2 normal evals from attendings but one eval where the guy didn't pass me because I didn't show enough interest and apparently did not present patients at a detailed enough level. (For my own defense, however, my husband was in the psych ward for part of that month with a suicidal ideation -- LONG story. So I felt like I was doing pretty good all things considered.)

Anyway, things have settled down in my personal life now and I think I will be much more professionally focused. (!) It scares me that these 6 months will be make it or break it, but you're right that I should be grateful that it's not worse.

 

[Top Gun]

Wow! Thanks for your replies. It really helps to put things in perspective. I am feeling so sorry for myself, but I guess all things considered I am pretty lucky. (Trying to convince myself....) But I know what you mean, it might be easier to dump me.

Although, looking at it from a PD's perspective, it is really not a good thing to lose residents. Not only does it bring down morale for the program, but when it comes time for renewal of the program, the PD has to explain the lower matriculation rate. It also screws up call schedules. But this is an aside.

In my case, my failed rotation was a weird situation. I had 2 normal evals from attendings but one eval where the guy didn't pass me because I didn't show enough interest and apparently did not present patients at a detailed enough level. (For my own defense, however, my husband was in the psych ward for part of that month with a suicidal ideation -- LONG story. So I felt like I was doing pretty good all things considered.)

Anyway, things have settled down in my personal life now and I think I will be much more professionally focused. (!) It scares me that these 6 months will be make it or break it, but you're right that I should be grateful that it's not worse.

That sounds like a bullsh*t reason to fail you on your eval: not showing enough interest and not presenting the patient in enough detail. If the attending wanted more details, he/she could have simply asked for them.
I would have tried appealing that one eval considering you had two other decent evals for the same rotation.

 

[TaiShan]

Let's be 100% clear about a few things:

1. After failing a rotation, your residency was guaranteed to be extended by one month. The boards are very clear about this -- you need XX months (36 for IM, my field) of satisfactory training. Making a month up leaves you a month short no matter how you slice it and dice it (unless you sacrifice some of your vacation, which most RRC's do not allow you to do). Once you take the LOA, you are now 2 months behind -- so extending by 6 months is really only an extra 4 months.

It is not true, at least in some other fields. I know my fellow interns failed multiple rotations and they are PGY2 now.

 

[yaah]

In my case, my failed rotation was a weird situation. I had 2 normal evals from attendings but one eval where the guy didn't pass me because I didn't show enough interest and apparently did not present patients at a detailed enough level.

But to be honest, nearly everyone who fails a rotation will say that their situation is unique, weird, or different. That's the point. And also to be honest, many times some attendings don't take the evaluation process seriously (either through lack of paying attention to your performance, disinterest in making waves or controversy, or whatever). So you should focus on the bad eval, not the normal ones. The bad one is likely to be the one that was more carefully thought out and reflective of reality. This is not to say that sometimes there aren't true vendettas out there, but not all bad evaluations are vendettas.

While it is true that at some programs you could probably fail a rotation or two and still get promoted, that's a red flag for the program. A program that allows this is taking the risk that they are training physicians who will not be qualified when they finish.

The above comments are very prescient. You are lucky that your program will stand up for you and allow you to do another 6 months of residency. They probably understand the circumstances and are willing to give you another chance, but I would not expect it to happen again. They also, however, are likely to be understanding if you need to take a further leave of absence to make sure you are ready and fully committed, and everything is well in your personal life, because that is the most important thing.

 

[PediBoneDoc]

But to be honest, nearly everyone who fails a rotation will say that their situation is unique, weird, or different. That's the point. And also to be honest, many times some attendings don't take the evaluation process seriously (either through lack of paying attention to your performance, disinterest in making waves or controversy, or whatever). So you should focus on the bad eval, not the normal ones. The bad one is likely to be the one that was more carefully thought out and reflective of reality. This is not to say that sometimes there aren't true vendettas out there, but not all bad evaluations are vendettas.

While it is true that at some programs you could probably fail a rotation or two and still get promoted, that's a red flag for the program. A program that allows this is taking the risk that they are training physicians who will not be qualified when they finish.

The above comments are very prescient. You are lucky that your program will stand up for you and allow you to do another 6 months of residency. They probably understand the circumstances and are willing to give you another chance, but I would not expect it to happen again. They also, however, are likely to be understanding if you need to take a further leave of absence to make sure you are ready and fully committed, and everything is well in your personal life, because that is the most important thing.

i completely agree.

all residents and medical students should understand that many people when they complete the evaluations do a general evaluation unless you have done something significantly bad or good. in our department, we have be given the mandate to complete the evaluations very honestly and if the meet the minimum requirements, they should get an average score. if we give a score of 5 or 1, we must give justification. therefore, i use those rarely unless it is warranted. when you fail someone you must have some justification.

if someone fails, there mus be a plan of remediation. probation is a very common way of making someone remediate without repeating the year.

i would say to TaiShan that if is there is a program with residents with multiple failures, those residents are most likely at risk for remediation, probation, or non-renewal of contract. The program likely has a plan for them.

 

[Tired]

This royally sucks and I don't want to be here.

I think your last statement here might tell the whole story.

 

[King Arthur]

i just wanna say that in the long run of a 30 or 40 year career six months probably won't feel like much, despite the fact that it sucks now.

 

[tibor75]

Too bad. You failed a rotation and you took personal time off. Just be thankful you have a job.

at the pathetic whining.

 

[prematch]

I have sympathy for you, but I also have few advices.
1. Do not play naive, you have come so far and your board scores are facts. Unless you have done harm to your patients. Whatever your attending or your PD tells you is just their ideas. Do not go after their pitty, you do not need it. They play this game to force you to believe that you are not competent but it is not true, All they are tying to do is cover themselves that they would not being questioned by RRC.
2. Do all of your communication in writings and if you think what they are doing is unfair, strongly and respectfully reject it.
3. Do not trust the PD, generaly PD is not your advocate. Be on your tip toes. Get your advices from professionals not even other residents or attendings in your program.
4. I have seen that the programs tend to deal with the fighter resident and keep them because they know they will go to everybody and create headaches but get rid of the naive ones because they believe the evals.
(I am trying to create a database for ACGME residency lawyer here for all of us).
5. Do not be afraid. Always do the right thing. You are your patients advocate. If your attendings or senior resident does any thing fishy, document it and write to your PD and ask for response in witing. You do not know about your attendings or senior resident credentials, how many failed attempts, felony, drugs etc.
6. Finaly we will live here for few more days and I hope every body would come to be with the King. So a career does not worth sorrowing and being worried.
Good luck🙂

 

[LADoc00]

how do you fail a rotation? Not show up? Are there tests you take at the end? Clue me in, Ive never heard of such things.

 

[yaah]

6. Finaly we will live here for few more days and I hope every body would come to be with the King. So a career does not worth sorrowing and being worried.

I'm not normally an internet grammar cop, but this is just too amazing to pass up without comment. It's almost artistic. Really impressive. It's so incoherent it's almost coherent if you read it quickly. I'm torn between the option that you did that intentionally just to see if anyone would catch it and the fact that you were trying to say something and it just came out wrong. Did you put something through babelfish?

 

[Doowai]

4. I have seen that the programs tend to deal with the fighter resident and keep them because they know they will go to everybody and create headaches but get rid of the naive ones because they believe the evals.
(I am trying to create a database for ACGME residency lawyer here for all of us)......... You do not know about your attendings or senior resident credentials, how many failed attempts, felony, drugs etc.

If it is true that a program will keep the fighter then fighting this may be worth it - I am not sure its true, perhaps program director can tell us. Things like felony arrests are public record and you can find this out - maybe it would be useful ammo for shooting down the person who gave you the bad eval.

Interesting food for thought - in business I use to keep a pocket recorder in my pocket at all times and when someone said something interesting I would click the record button discretely (people never noticed) and start recording - had detailed records of employees and clients detailing sordid details of their sex lives , cheating on their husbands, drug use etc - came in handy quite a few times, it allowed me to wield powerful influence over several people (in my state its legal to record a conversation without the other person knowing). I had never thought of using this with an attending - but recording any harrassing intimidating innapropriate comments from the attending, along with a detailed background search on each attending, might yield enough evidence in such a case as to give enough ammo for a good defense (or offense) as an intern.

Thanks for sharing your story, very practical and informative post

 

[bulgethetwine]

If it is true that a program will keep the fighter then fighting this may be worth it - I am not sure its true, perhaps program director can tell us. Things like felony arrests are public record and you can find this out - maybe it would be useful ammo for shooting down the person who gave you the bad eval.

Interesting food for thought - in business I use to keep a pocket recorder in my pocket at all times and when someone said something interesting I would click the record button discretely (people never noticed) and start recording - had detailed records of employees and clients detailing sordid details of their sex lives , cheating on their husbands, drug use etc - came in handy quite a few times, it allowed me to wield powerful influence over several people (in my state its legal to record a conversation without the other person knowing). I had never thought of using this with an attending - but recording any harrassing intimidating innapropriate comments from the attending, along with a detailed background search on each attending, might yield enough evidence in such a case as to give enough ammo for a good defense (or offense) as an intern.

Thanks for sharing your story, very practical and informative post

I'm laughing so hard at you right now. Seriously. You are so Jerry Springer... you don't have the integrity of an illusion.

 

[fang]

I think you need to take a strong, honest look at what got you in this situation instead of deflecting the blame to your husband, your kids, or a fluke evaluation. I can definitely understand how the stress you described could throw anyone for a loop and cause them to lose focus on work. However, if that's the case and you have an unmanageable amount of responsibility between being an intern, mom, and major support for your husband, maybe you should rearrange things so that you can reasonably fulfill your various roles. The evaluator was not telling you literally you're too cursory; he was telling you that he/she doesn't think you're ready to be an intern and being too cursory is one of the signs. Maybe that's because while your classmates were going home and sleeping a pitiful 6 hours to drag their butts back to the hospital to be minimally functional, you only slept for 2 hours because of your husband's needs, and were exhausted and incompetent the next day... its understandable, but it still means you're not ready for the next step.

Prioritize which responsibilities mean the most to you, and do those things well; by trying to take on everything at once you may be setting yourself up to fail.

 

[Doowai]

I'm laughing so hard at you right now. Seriously. You are so Jerry Springer... you don't have the integrity of an illusion.

Gosh, thanks. Believe me you have heard nothing yet. When I did a rotation in a state prison, I often found myself looking at convicts and thinking : Wow, I am way more criminal than you. It was sobering, enlightening and motivating all at once.

 

[nykka3]

Interesting food for thought - in business I use to keep a pocket recorder in my pocket at all times and when someone said something interesting I would click the record button discretely (people never noticed) and start recording - had detailed records of employees and clients detailing sordid details of their sex lives , cheating on their husbands, drug use etc - came in handy quite a few times, it allowed me to wield powerful influence over several people (in my state its legal to record a conversation without the other person knowing). I had never thought of using this with an attending - but recording any harrassing intimidating innapropriate comments from the attending, along with a detailed background search on each attending, might yield enough evidence in such a case as to give enough ammo for a good defense (or offense) as an intern.

😱
which state is this legal?

 

[bulgethetwine]

Gosh, thanks. Believe me you have heard nothing yet. When I did a rotation in a state prison, I often found myself looking at convicts and thinking : Wow, I am way more criminal than you. It was sobering, enlightening and motivating all at once.

This is hilarious! Tell me more I'm dying to know! At first I thought you were crazy, now I'm just interested. Bring it on!😀

 

[captaincrunch]

Your situation certainly sucks. I have been on the receiving end of negative evaluations, and they sting (luckily, I haven't had to repeat a rotation). I have learned that a the signal-to-noise ratio on these things is pretty bad. Personal conflicts often find their way into resident evaluations, which has very little to do with patient care. My experience has taught me, however, to avoid focusing on the unfairness of the evaluations. While your program director and attendings may be unaware of the personal events in your life, they are clearly picking up on something that is affecting your performance. Your clinical knowledge may be sufficient, but there may be something to change in your approach. I suspect that this will happen on its own as you work on your personal problems. Remember, a lot of residents have been forced to do remediation, and have continued on to be excellent residents. It sucks, and you probably feel betrayed by your attending, but make an effort to turn this into a learning experience for yourself.

My second piece of advice is more broad. We are taught too often to think of medicine as this higher calling to which we much devote our entire selves. It is this thinking that allows us to work so hard for so little money. But in the end, this simply isn't true. Doctors aren't special, and our work isn't so important that you should sacrifice yourself to do it. The worst-case scenario is that you have to drop out of residency or take an extended leave-of-absence. Neither scenario is terrible. Your life and career will continue. Your family and personal happiness is more important than your residency. Perhaps you should consider taking a six-month leave of absence, if you have enough money. You can then make-up your six months and start your R2 year next year. You and your family come first; your job comes second.

Good luck.

 

[chiki124]

that's really a bad news, it happened to one of my friend when he was at final year just 3 months to go period, the reason was that he took 3 sick days (extra) and 2 extra vacation days total 5 days in the period of 6 months time frame and u know what the Program Director says "its their hospital policy to terminate the program but since you are at the final year and almost 3 months to go I am giving you a chance to extend for another 6 months"...can u believe this...BTW are u also an IMG???? this looks like some political things happened...6 months cheap work...who will work a full time physician for cheap...anyway I am sorry to hear about your extension and good luck with your rest of the residency..

 

[zzzzzz]

You know, I am definitely trying to look at this in a positive light, and I appreciate all the replies. For one thing, I'll have a year experience under my belt, but I'll still write PGY 1 on everything. So attendings who don't know any better will think I'm just a stellar new intern. 😀 And the seniors I'm on call with are happy because they don't have to train me like a new intern. So little things like that are good. But ultimately I have to realize that this time will only make me a better physician if I allow it to. I am feeling more peace. Ahhhh..... And I am making a concerted effort to settle things down in the personal life arena as much as possible. I know I can do this stuff just fine; it is just a matter of getting myself together. (No, I'm not an IMG by the way).

 

[LADoc00]

I use to keep a pocket recorder in my pocket at all times and when someone said something interesting I would click the record button discretely (people never noticed) and start recording - had detailed records of employees and clients detailing sordid details of their sex lives , cheating on their husbands, drug use etc - came in handy quite a few times, it allowed me to wield powerful influence over several people

Umm remind me never to piss you off...where did you go to biz school? School of Dirty Rotten Scoundrels??

 

[Top Gun]

If it is true that a program will keep the fighter then fighting this may be worth it - I am not sure its true, perhaps program director can tell us. Things like felony arrests are public record and you can find this out - maybe it would be useful ammo for shooting down the person who gave you the bad eval.

Interesting food for thought - in business I use to keep a pocket recorder in my pocket at all times and when someone said something interesting I would click the record button discretely (people never noticed) and start recording - had detailed records of employees and clients detailing sordid details of their sex lives , cheating on their husbands, drug use etc - came in handy quite a few times, it allowed me to wield powerful influence over several people (in my state its legal to record a conversation without the other person knowing). I had never thought of using this with an attending - but recording any harrassing intimidating innapropriate comments from the attending, along with a detailed background search on each attending, might yield enough evidence in such a case as to give enough ammo for a good defense (or offense) as an intern.

Thanks for sharing your story, very practical and informative post

You know, after reading this, I'm beginning to wonder if the residency directors who rejected you saw this side of your personality and thus decided to blackball you.

 

[sophiejane]

I'm not normally an internet grammar cop, but this is just too amazing to pass up without comment. It's almost artistic. Really impressive. It's so incoherent it's almost coherent if you read it quickly. I'm torn between the option that you did that intentionally just to see if anyone would catch it and the fact that you were trying to say something and it just came out wrong. Did you put something through babelfish?

I love SDN. I really, really love it.

😍

 

[deleted87716]

Finaly we will live here for few more days and I hope every body would come to be with the King. So a career does not worth sorrowing and being worried.

I'm not normally an internet grammar cop, but this is just too amazing to pass up without comment. It's almost artistic. Really impressive. It's so incoherent it's almost coherent if you read it quickly. I'm torn between the option that you did that intentionally just to see if anyone would catch it and the fact that you were trying to say something and it just came out wrong. Did you put something through babelfish?

Just for kicks, I ran prematch's comment through Babelfish, and here's what came out:

"Life is short. It's only a job...try to keep things in perspective."

I think they've improved Babelfish since the last time I used it. 😉