What are the implications of academic probation during residency?

[titan78]

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So, during the early part of my residency, my program placed me on academic probation, for academic reasons obviously. Many residents in my program get a printout of their in-training exams with the label saying academic probation, due to their test scores.

I was removed from academic probation and I am in academic good standing.

Now, I am applying for licensure in a certain state, and on the application, it is asking if I have ever been on academic probation. It also requires an explanation.

What are the odds of licensure denial based on this alone? Is it unreasonable to even worry about this? Will this stuff follow me around forever? Can it mess up my career?

 

[docB]

Interesting question. I would think that you would not be denied a license because of this since you worked your way out of the situation. I imagine they would be a lot more sticky about someone placed on AP for cheating.

It's also such a program dependent thing. You could get put on formal AP at one program and nothing would happen at another. I recall doing pretty poorly on one inservice. I got called into the PD's office and got a lecture about reading. But I never got placed of a formal AP. I imagine you and I were really in the same situation but my program didn't saddle me with the AP label. Tough break but I really think it'll be OK in the end.

 

[razorback58]

I do think that academic probation secondary to cheating could be a problem. There have been sooooooooo many medical students that failed a class etc.... and I don't think they are interested in that.

They are more interested in academic probation due to cheating, problems with anger management and disrespect etc.....


Don't worry about this. I really do not think it is going to be a problem.

 

[Winged Scapula]

I agree with the others - the reasons for academic probation are so variable that the state probably just wants to verify what the reasons are and then treat the issue of licensing on a case by case basis.

Since you obviously graduated and are BE/BC, I wouldn't imagine it (the AP) in your case would be a problem.

 

[NotAProgDirector]

Several things:

1. The IM in training exam is NOT allowed to be used to put someone on probabtion. Other specialties may have other rules, but the IM-ITE is designed so that residents can assess their knowledge in a "safe" way, and so that programs can tailor their program curricula. Other fields may have different rules.

2. Not reporting the probation (because now it is lifted) can be considered fraud, and lead to your denial/withdrawal of a license. Hence, you should get legal advice if you decide not to report it on your application.

3. Many programs have a "remediation" and "probation" program. Remediation is an internal, QA protected process and hence is not reportable. Make sure that you were on true probation before you start reporting it.

 

[LADoc00]

Im really quite amused by "AProgDirector" having a Sith Lord avatar....

Its almost like PDs have just thrown off the sheep's clothing and are running free!

 

[Winged Scapula]

Several things:

1. The IM in training exam is NOT allowed to be used to put someone on probabtion. Other specialties may have other rules, but the IM-ITE is designed so that residents can assess their knowledge in a "safe" way, and so that programs can tailor their program curricula. Other fields may have different rules.

Other fields have the same rules. However, not all PDs are sticklers for the rules as you are - stories of residents in many specialties, at many hospitals, being fired or put on probation for in-training exam scores are legion.

 

[NotAProgDirector]

Other fields have the same rules. However, not all PDs are sticklers for the rules as you are - stories of residents in many specialties, at many hospitals, being fired or put on probation for in-training exam scores are legion.

Certainly true, and there is nothing anyone can really do about it. The only enforcible sanction available is preventing a program from having access to the ITE, and that would probably hurt residents more than programs.

Although I'm happy to try and answer questions / help here, it's truly depressing to hear about my colleagues behaving badly.

 

[NotAProgDirector]

Im really quite amused by "AProgDirector" having a Sith Lord avatar....

Its almost like PDs have just thrown off the sheep's clothing and are running free!

I find your lack of faith disturbing.

 

[Winged Scapula]

Certainly true, and there is nothing anyone can really do about it. The only enforcible sanction available is preventing a program from having access to the ITE, and that would probably hurt residents more than programs.

Although I'm happy to try and answer questions / help here, it's truly depressing to hear about my colleagues behaving badly.

I agree - I have to say it was one the saving elements of my program that they didn't do that to us during my tenure there.

Residents have enough to worry about without thinking they're going to be fired or put on AP because of their exam score. Its too bad that it isn't enforced but since most residents make mistakes, I wouldn't put it past dirty PDs to simply find another "reason" to fire someone if they couldn't use the ITE.

But why can't the ITE scores simply be submitted to the resident rather than the program and the resident can give them up voluntarily if they want for program data collection?

 

[phoenix77]

But why can't the ITE scores simply be submitted to the resident rather than the program and the resident can give them up voluntarily if they want for program data collection?

Because then programs with poor academics would really be held accountable for their teaching, or lack thereof, since the belief is that people who do poorly on the ITEs will do poorly on the boards. I find it hilarious that the ACGME/RRC explicitly says that ITEs can't be one and unto themselves be used to bar someone from being promoted or be the cause of disciplinary action, and yet, at least the ABSITE, at the very beginning of the test, asks what score will your program use as the bar for possible disciplinary action. IMHO, I think ITEs should be given at the end of the academic year so results could not be used in against residents, or results of the ITEs could come out in July so that it does not become a tool to base promotion on.

 

[titan78]

Thanks for the encouraging comments. I am sure I will have to report it at some point (application process). I emailed my PD asking the PDs advice, and this person has not responded yet. I still have a year left in residency, and I am not even positive I will be leaving this state-where I am fully licensed and they do have record of this AP on file-and there is no issue at all here.

There was no wrongdoing, confrontation, cheating, lying, stealing, substance abuse, or patient abuse involved. This was simply based on in-training scores, and negative subjective comments regarding skills and knowledge. Personality, work ethic, and attitude has never been in question based on the written evals that I have seen, and I have all the official evals.I was fully cooperative with the remediation process and met their demands in clinical skills and exam scores. My PD recently wrote me Letters of Rec for fellowship applications.

I think the main information that I seek is how to explain the situation being completely honest, yet doing the least amount of career harm to myself inthe process. Hopefully, my PD will help me present the information in a good way.

 

[NotAProgDirector]

But why can't the ITE scores simply be submitted to the resident rather than the program and the resident can give them up voluntarily if they want for program data collection?

I use the scores to help target aid to my residents. Those scoring poorly are offered an optional reading / studying program. I also limit moonlighting for those with poor test scores (as I think their time would be better used reading). Being blinded to the scores would seriously impair my ability to help my residents.

Therein lies the rub -- blinding the scores prevents the "evil" PD's from misusing them, but also prevents us Sith Lords from actually trying to help. I guess if they were given to residents directly those that trusted their PD's could release them. Could lead to some seriously awkward moments, and the evil PD's could simply put anyone on probation who didn't show them their scores. Pick your poison.

 

[Adam_K]

Therein lies the rub -- blinding the scores prevents the "evil" PD's from misusing them, but also prevents us Sith Lords from actually trying to help. I guess if they were given to residents directly those that trusted their PD's could release them. Could lead to some seriously awkward moments, and the evil PD's could simply put anyone on probation who didn't show them their scores. Pick your poison.

The only way to limit the power of Petty Dictators is to expose them to the marketplace. If residents are able to change residencies postmatch the same way that others are able to switch jobs such abuses would be few and far between. Central Committee decrees do little to improve the resident's lot.

 

[Winged Scapula]

I use the scores to help target aid to my residents. Those scoring poorly are offered an optional reading / studying program. I also limit moonlighting for those with poor test scores (as I think their time would be better used reading). Being blinded to the scores would seriously impair my ability to help my residents.

Therein lies the rub -- blinding the scores prevents the "evil" PD's from misusing them, but also prevents us Sith Lords from actually trying to help. I guess if they were given to residents directly those that trusted their PD's could release them. Could lead to some seriously awkward moments, and the evil PD's could simply put anyone on probation who didn't show them their scores. Pick your poison.

There's really no good answer is there. Damned if you do, damned if you don't.

 

[cchoukal]

I sit on the Graduate Medical Education Committee at my hospital, and there's recently been a lot of talk about what terms to use to describe a resident who needs a little extra help/guidance/time, whatever, in order to get where they need to be. The issue is that, at least according to our committee, is that certain terms like "remediation" and "probation" are solicited not so much by state licensing boards, but by potential employers. That is, when you graduate and apply for privleges at hospital X, they will contact your program director and ask, "was so and so ever on probation, in remediation..." and so on with a couple other like terms. I'm not sure how much detail the PDs/hospitals go into, and whether extenuating factors are discussed, or whatever.

So our committee's goal was to identify people who are sort of at risk and give them some help in a way that wouldn't have to be described as remediation or probation, as those specific terms were sought by credentialing agencies...

 

[NotAProgDirector]

So our committee's goal was to identify people who are sort of at risk and give them some help in a way that wouldn't have to be described as remediation or probation, as those specific terms were sought by credentialing agencies...

I ran into this same problem. Some state board licence apps are ridiculously vague and intrusive. Questions like "Has this physician received any negative evaluations / reports?". What in the world does that mean? Every once in awhile I receive an angry letter from a patient, do I have to report that? Each of my residents' evaluations has an "area for improvement" section, do I need to report that?

We "solved" this by doing the following: In my program's policy manual, we defined two "statuses" that we could put residents into if they run into trouble, "remediation" and "probation". We clearly defined remediation as a Quality Assurance process, and we follow all of the QA statues in our state (i.e. records are kept separate in their file, locked at all times, limited access, etc). The magic here is that since they are QA documents, they are not releasable to outside parties. So, when I am asked if someone who was put on remediation and then resolved it had any "negative evaluations", the answer is no (because the remediation is QA).

Probation, on the other hand, is not QA protected by our definition. Hence, anyone put on probation then has permanent documentation of that in their record, that would be released to outside parties.

Usually, residents are put on remediation first, given a specific timeframe to improve, and then are cleared or put on probation (although I have extended remediation for residents who have made progress but not yet completely resolved the issue). Serious offenses / issues can result in direct probation. I also give residents the choice of resigning rather than going on probation -- I work with them to find a new program for them, and this saves them any potential future hassle from a probationary status issue.

Does it work? From a resident standpoint, so far so good. From a legal standpoint, it hasn't been tested yet in court but hospital legal counsel likes it.

 

[swpm]

1. The IM in training exam is NOT allowed to be used to put someone on probabtion. Other specialties may have other rules, but the IM-ITE is designed so that residents can assess their knowledge in a "safe" way, and so that programs can tailor their program curricula. Other fields may have different rules.

As a resident, I feel much more comfortable with my program evaluating me and judging me based on my ITE score (which ranks me relative to 1000+ peers) ... when the alternative is a bunch of subjective staff opinions generated after occasional observations of me reacting to random pimping during conferences, and recorded in a half-assed way on my semi-annual eval.

My program is going to judge and rank me, period. Better, IMO, that at least part of that is based on something 100% objective.

As a tool for self-evaluation, I think the ITE is not helpful. As for "safe" methods of self-evaluation, I find board prep question books much better. I can use them whenever I want. I can use them more than once. I get immediate feedback on what I know and don't know, and further explanations/references for what I miss. The ITE gives me a list of keywords in areas I missed questions. Oooh, yay.

I guess what I'm getting at is that I think the ITE is a far better tool for evaluation than teaching.

 

[ajce9]

I find your lack of faith disturbing.

Maybe it has to do with some of those no so honest program directors you just mentioned. 😀

 

[ajce9]

I ran into this same problem. Some state board licence apps are ridiculously vague and intrusive. Questions like "Has this physician received any negative evaluations / reports?". What in the world does that mean? Every once in awhile I receive an angry letter from a patient, do I have to report that? Each of my residents' evaluations has an "area for improvement" section, do I need to report that?

We "solved" this by doing the following: In my program's policy manual, we defined two "statuses" that we could put residents into if they run into trouble, "remediation" and "probation". We clearly defined remediation as a Quality Assurance process, and we follow all of the QA statues in our state (i.e. records are kept separate in their file, locked at all times, limited access, etc). The magic here is that since they are QA documents, they are not releasable to outside parties. So, when I am asked if someone who was put on remediation and then resolved it had any "negative evaluations", the answer is no (because the remediation is QA).

Probation, on the other hand, is not QA protected by our definition. Hence, anyone put on probation then has permanent documentation of that in their record, that would be released to outside parties.

Usually, residents are put on remediation first, given a specific timeframe to improve, and then are cleared or put on probation (although I have extended remediation for residents who have made progress but not yet completely resolved the issue). Serious offenses / issues can result in direct probation. I also give residents the choice of resigning rather than going on probation -- I work with them to find a new program for them, and this saves them any potential future hassle from a probationary status issue.

Does it work? From a resident standpoint, so far so good. From a legal standpoint, it hasn't been tested yet in court but hospital legal counsel likes it.

Just out of curiousity, why couldn't you get rid of the term remediation all together.

Let me explain. Residents are in training. when someone is in training they make mistakes. Different residents have different levels of strength. So. they make different or more or less mistakes. But you know all of this already.

So, why not just write of all of this as a training experience and only focus and write policy on the part about a real error and what makes a real probation.

this way you can answer NO to the states or hospital question about if the resident has ever had remidiation. The way your residency describes it now it seem that it still puts the resident at risk.

If a resident does not make progress or is slow in progress that can be handled internally but does not have to be reported to the state or future employee because based on the policy you wrote it was not considered a remidiation or probation.

 

[NotAProgDirector]

Just out of curiousity, why couldn't you get rid of the term remediation all together.

Good question. Two main reasons:

1. My GME office has defined a remediation/probation policy, which I have to follow. Academic due process requires that I follow standard procedures for my institution, and so I'm really stuck with it whether I like it or not. If I simply got rid of remediation altogether, and then put a resident on probation, they could argue that it was "not valid" because they were not on remediation first (and win).

2. More importantly, a significant subset of residents who need remedial plans do not "get it". I sit down with them, review the problem, work out a plan, and put it in writing. 3 months later, no improvement, and I tell them I'm putting them on probation. They get upset, say I didn't warn them, etc. An official remediation step makes it very clear how serious the situation is, without putting the resident's career at risk. Because remediation plans are QA, I am under no requirement to keep them after the resident graduates -- they all go to the shredder.

 

[titan78]

My PD discussed the issue with the local GME office, and I believe the Dean's of the College of Medicine. The net result is: they believe it is reportable, and even more importantly to me is that my PD and these people do not think it will impede me obtaining medical licensure in the state where I plan on practicing when I am done.

Thanks to all who where helpful/responded to my inquiry.

Onward....