I have a problem currently and would like some input from other forum members (especially attendings)
I am currently an AMG PGY-2 resident at a very good academic IM residency program. I was told after several weeks of remediation that I have to resign or be terminated.
The story is as follows:
During intern year I felt as if I did not have a good fund of knowledge and was inefficient, sometimes staying until very late, but until the last two months of intern year I did not receive negative feedback. My midterm ABIM evaluation was alright, even above class average. I even got comments such as "very efficient" and "good fund of knowledge" and "you have good plans on your patients" from attendings. Some senior residents and fellows told me that they thought I was ready to be a PGY-2, even though I did not feel ready at all. I think it was around the last two months of intern year that attendings start to expect you to show signs of becoming a PGY-2, so while I was okay in their eyes as an intern, they did not think I was ready for PGY-2 at the very end, but no one failed me in PGY-1 and I advanced, though I did receive negative feedback on my last 2 rotations.
Thus I started PGY-2 with a good deal of apprehension and had trouble adjusting to the PGY-2 responsibilities, both because of deficiencies and because of apprehension. I had trouble being organized and prioritizing patient issues (this skill seemed to even regress compared to when I was an intern) such that I did not take care of the very sick in a timely manner, and a lab needing follow-up got missed. I also sometimes misspoke about patients which confused people (got different patients' data mixed up), so I had communication issues as well.
I was placed in a remediation program for several weeks and made improvements and regained some confidence until I missed treating another sick patient, due to residual deficiency as well as building apprehension as my remediation period was drawing to a close. As this was towards the end of the remediation period, I was told that I should resign or be terminated.
I think my mistakes are serious and I surely do not want to make those mistakes again. I also think that I can come out of this mess a respectable physician. I think that my problems stem from going into intern year with too much confidence (at medical school graduation I felt like my fund of knowledge was great, and didn't feel scared my first week of intern year like normal people are, perhaps a bad sign), expecting patient care practices to just "fall into place" after doing it for awhile (instead of actively seeking to acquire certain skills that I may be naturally weak at). After receiving notification that I couldn't continue in the program, I asked for feedback from my program director on ways to improve, and received some. The PD was supportive of me continuing on in internal medicine (so the PD thinks I can do it, or else would tell me to switch careers, right?). I took a good long look at myself, my deficiencies (especially with critically ill patients), and made a list of concrete things to work on. I also took Step 3 and feel that I passed comfortably. While preparing for Step 3 I practiced with CCS cases, and although those "patients" are not nearly as complicated as real-life ones, I feel that for the first time I have developed a good systematic way of approaching patients, both ensuring their stability/safety and working them up and treating them within time constraints. I think I have a much better grasp of patient care now compared to when I just started PGY-2 (when I felt really lost), and am looking at other medicine residencies (I resigned instead of being terminated). I left my program on good terms and plan to keep the PD updated about my activities.
I have a couple of questions:
1. I would like to put my newly acquired habits/skills into practice (especially with multiple patients, not just single CCS cases) before starting residency again - any way to volunteer as a physician (doing pre-med stuff won't help) without a license (Step 3 scores won't be back until April since I took the new administration), under some supervision because I know I will need advice from more experienced people though I generally am independent in my thinking, and without all the high stakes of residency (don't want to fail again).
2. What is the usual course of my case? What medicine residencies can I expect to obtain? Fellowships in the future? Of course, provided that I am ultimately successful at completing residency.
My background: AMG from a very good medical school (top 30?), 3rd quartile of med school class (sort of middle 3rd quartile), 220s step 1, 260s step2, > 80th percentile on in-training exam taken as PGY-2, step3 taken with score pending; no history of academic/professionalism/ethical/personality disorder/depression/anxiety disorder/substance abuse issues in medical school or residency.
I appreciate any input. Would also be glad if someone can comment on ways of dealing with PGY-2 year that they found worked for them. Thanks!
I am currently an AMG PGY-2 resident at a very good academic IM residency program. I was told after several weeks of remediation that I have to resign or be terminated.
The story is as follows:
During intern year I felt as if I did not have a good fund of knowledge and was inefficient, sometimes staying until very late, but until the last two months of intern year I did not receive negative feedback. My midterm ABIM evaluation was alright, even above class average. I even got comments such as "very efficient" and "good fund of knowledge" and "you have good plans on your patients" from attendings. Some senior residents and fellows told me that they thought I was ready to be a PGY-2, even though I did not feel ready at all. I think it was around the last two months of intern year that attendings start to expect you to show signs of becoming a PGY-2, so while I was okay in their eyes as an intern, they did not think I was ready for PGY-2 at the very end, but no one failed me in PGY-1 and I advanced, though I did receive negative feedback on my last 2 rotations.
Thus I started PGY-2 with a good deal of apprehension and had trouble adjusting to the PGY-2 responsibilities, both because of deficiencies and because of apprehension. I had trouble being organized and prioritizing patient issues (this skill seemed to even regress compared to when I was an intern) such that I did not take care of the very sick in a timely manner, and a lab needing follow-up got missed. I also sometimes misspoke about patients which confused people (got different patients' data mixed up), so I had communication issues as well.
I was placed in a remediation program for several weeks and made improvements and regained some confidence until I missed treating another sick patient, due to residual deficiency as well as building apprehension as my remediation period was drawing to a close. As this was towards the end of the remediation period, I was told that I should resign or be terminated.
I think my mistakes are serious and I surely do not want to make those mistakes again. I also think that I can come out of this mess a respectable physician. I think that my problems stem from going into intern year with too much confidence (at medical school graduation I felt like my fund of knowledge was great, and didn't feel scared my first week of intern year like normal people are, perhaps a bad sign), expecting patient care practices to just "fall into place" after doing it for awhile (instead of actively seeking to acquire certain skills that I may be naturally weak at). After receiving notification that I couldn't continue in the program, I asked for feedback from my program director on ways to improve, and received some. The PD was supportive of me continuing on in internal medicine (so the PD thinks I can do it, or else would tell me to switch careers, right?). I took a good long look at myself, my deficiencies (especially with critically ill patients), and made a list of concrete things to work on. I also took Step 3 and feel that I passed comfortably. While preparing for Step 3 I practiced with CCS cases, and although those "patients" are not nearly as complicated as real-life ones, I feel that for the first time I have developed a good systematic way of approaching patients, both ensuring their stability/safety and working them up and treating them within time constraints. I think I have a much better grasp of patient care now compared to when I just started PGY-2 (when I felt really lost), and am looking at other medicine residencies (I resigned instead of being terminated). I left my program on good terms and plan to keep the PD updated about my activities.
I have a couple of questions:
1. I would like to put my newly acquired habits/skills into practice (especially with multiple patients, not just single CCS cases) before starting residency again - any way to volunteer as a physician (doing pre-med stuff won't help) without a license (Step 3 scores won't be back until April since I took the new administration), under some supervision because I know I will need advice from more experienced people though I generally am independent in my thinking, and without all the high stakes of residency (don't want to fail again).
2. What is the usual course of my case? What medicine residencies can I expect to obtain? Fellowships in the future? Of course, provided that I am ultimately successful at completing residency.
My background: AMG from a very good medical school (top 30?), 3rd quartile of med school class (sort of middle 3rd quartile), 220s step 1, 260s step2, > 80th percentile on in-training exam taken as PGY-2, step3 taken with score pending; no history of academic/professionalism/ethical/personality disorder/depression/anxiety disorder/substance abuse issues in medical school or residency.
I appreciate any input. Would also be glad if someone can comment on ways of dealing with PGY-2 year that they found worked for them. Thanks!
