Am I in trouble? Eval states I am a "below-average" resident

[NeurologyHopeful2018]

Finished an IM Ward month. Had an attending who had super high expectations. I made mistakes here and there, but was able to complete my work competently and efficiently. His final eval stated "John Smith gave an overall below-average performance, he needs to work on his medical knowledge, some gaps may adverse patient care". My previous 6 evaluations were all solid-excellent, and my first couple in the beginning of the year were so-so. No other issues in residency so far. Would this trigger my PD calling me into his office/risk of putting me on probation?

An Neurology resident doing IM prelim year at the same institution.

Thank you!!

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[Raryn]

You're fine.

One soft evaluation with a backdrop of multiple prior good evaluations, 10 months in to internship is meaningless unless there are explicit professionalism concerns. Your program director will only care if there's a trend of poor evaluations - and your trend is the opposite.

 

[VA Hopeful Dr]

You're fine.

One soft evaluation with a backdrop of multiple prior good evaluations, 10 months in to internship is meaningless unless there are explicit professionalism concerns. Your program director will only care if there's a trend of poor evaluations - and your trend is the opposite.

Mostly agree.

If you're really worried, you can always talk to the PD. Phrase it that you're worried because you had thought you were doing well and then this came up.

Same thing happened to me at this point intern year. Turned out it was a peds attending who was notorious for being harsh on evals. Nothing ever came of it.

 

[jhamaican]

someone has to be below average.

 

[Winged Scapula]

Yeah, most of us have encountered someone like that.

We had a Vascular Surgery attending who was notorious for writing things like, "functions at the level of a 3rd year medical student" etc on his evals. He wasn't missed when he went on sabbatical and when he didn't return.

If everything else is good, I wouldn't sweat it.

 

[mvenus929]

FWIW, I had a weird evaluation halfway through intern year. They said my knowledge was poor and I was way behind my peers, or something to that effect. I had my semi annual review with my APD, who worked with me clinically multiple times, and he basically said ‘I really don’t understand where this evaluation came from. This doesn’t describe you at all’. And everything was fine.

 

[splik]

50% of residents are below average. medical knowledge deficits are not usually a big thing as they can be remedied and your knowledge should grow. issues related to professionalism are more of an issue. I am more troubled by the attendings use of "adverse" as a verb. If there were really concerns about patient care, your evaluation should not be the first you are hearing about it. These things should not just be on an end of rotation evaluation but have been escalated to the chief resident, site director and/or PD. It would be unfair for anyone to significantly respond to a vague evaluation with poor grammar. If you are concerned you could always ask the attending for more specific feedback on areas of weakness to improve upon or ask your advisor/chief/etc if there there are any concerns about you. It shows a great deal of maturity to tackle things head on and shows you are serious about addressing any deficits, be they real or imagined.

 

[Merely]

Finished an IM Ward month. Had an attending who had super high expectations. I made mistakes here and there, but was able to complete my work competently and efficiently. His final eval stated "John Smith gave an overall below-average performance, he needs to work on his medical knowledge, some gaps may adverse patient care". My previous 6 evaluations were all solid-excellent, and my first couple in the beginning of the year were so-so. No other issues in residency so far. Would this trigger my PD calling me into his office/risk of putting me on probation?

An Neurology resident doing IM prelim year at the same institution.

Thank you!!

You’re neurology, why do you care what an off service attending thinks..?

 

[jhamaican]

Always hated those passive aggressive attendings who would trash you in the eval, but never say anything in person while on the actual rotation when it matters most.

You are a neuro prelim who is getting trashed by a passive aggressive medicine attending.

Just make it through the year then you can tell them to shove it.

 

[Coupd'Cat]

Finished an IM Ward month. Had an attending who had super high expectations. I made mistakes here and there, but was able to complete my work competently and efficiently. His final eval stated "John Smith gave an overall below-average performance, he needs to work on his medical knowledge, some gaps may adverse patient care". My previous 6 evaluations were all solid-excellent, and my first couple in the beginning of the year were so-so. No other issues in residency so far. Would this trigger my PD calling me into his office/risk of putting me on probation?

An Neurology resident doing IM prelim year at the same institution.

Thank you!!

There's also a chance that this attending is already known to other residents and the PD for tossing around unfounded feedback. I'd say that's the more likely pattern, since your other evals sound fine.

I've known residents who ask the PD to remove outlier evals if they are truly egregious ("does not know how to use a reflex hammer" regarding PGY4 Neurology resident) and the principle of the thing bothers them enough.

 

[jurassicpark]

The only problem I see is "may adverse patient care." He may be inferring you're a danger to patients in which I would definitely talk to the PD or whomever to make sure this is not a problem. A below average eval though is far from unheard of, but don't make it a habit.

 

[NickNaylor]

One negative evaluation does not a bad resident make. If the rest of your evaluations have generally been positive, one negative evaluation should be viewed for what it is: anomalous. I do think it would probably be worthwhile to see if there's anything actionable that you can actually gleam from the evaluation and improve your performance, but even then sometimes that's not possible.

I wouldn't worry about it too much.

 

[SchoolBoy30]

Yep, you're good. No one ever got fired because of what IM thought of them. In fact your not an IM physician. A neurology attending may be a different story. But they are not about to fire a neurology resident AND make an entire class of neurology residents take extra call for 4 YEARS because of one subpar IM attending's evaluation. They don't care. Just make sure to smile and work hard for the neurology rotations and you'll be good.

 

[rokshana]

Yep, you're good. No one ever got fired because of what IM thought of them. In fact your not an IM physician. A neurology attending may be a different story. But they are not about to fire a neurology resident AND make an entire class of neurology residents take extra call for 4 YEARS because of one subpar IM attending's evaluation. They don't care. Just make sure to smile and work hard for the neurology rotations and you'll be good.

But he is an IM intern so, yes they can hurt him since he is not yet a neurology resident.
Will it, doubtful. As others have said, it’s the anomaly in his evaluations, so unlikely to be an issue, but not for the reasons you have stated...prelims are not above reprimand ...this just isn’t one of those cases.

 

[Freeinfinity]

You’ll be fine. One bad eval alone is not gonna hurt you. Like others have mentioned, the attending who graded you harshly is probably known to be a person who has unreasonably high expectations or perhaps there was a personality clash and he had a poor impression of you from the very beginning.

I had an attending during my medicine intern year who would freak out if there were spelling mistakes in our notes or when we would refer to brand names for meds in our plan instead of the generic name. Who the hell types up leviteracetam each time anyways?

Our notes as result eventually turned out to be mini essays. People were like “why is your note so long?”

Just make a note that Everyone has their own work style and that the attending you worked with was very particular and just did not mesh with yours.

 

[IonClaws]

Honestly, no. I don't think you're in trouble. As a fellow Neurology resident and someone who has been in my PD's office before for my evals on IM months (and is moving onto PGY-2 of Neurology), some IM attendings are god-awful, and seem to target non-IM residents more than others. There are 2 reasons for this.

1. They are bigoted toward you because you're not an IM resident and perceive anything you do worse than they would an IM resident;

2. IM really blows, not only because it's a dumping ground for crap no one else wants to deal with, but also because it's where most social work garbage ends up, and the problems the patients have tend to be extraordinarily boring, tedious, and numerous. Because of this, the residents and attendings alike are miserable unless there's something better on the horizon (i.e. fellowship). This is reflected in the "high expectations" some have of residents (i.e. I hate my job and I'll feel better if I take it out on the residents).

I'm not saying Neurology doesn't have its boring stuff/bad consults (altered mental status, head pain, etc.), but it seems like this stuff makes up most of IM, and whatever is more interesting ends up getting consults.

 

[NotAProgDirector]

2. IM really blows, not only because it's a dumping ground for crap no one else wants to deal with, but also because it's where most social work garbage ends up, and the problems the patients have tend to be extraordinarily boring, tedious, and numerous. Because of this, the residents and attendings alike are miserable unless there's something better on the horizon (i.e. fellowship). This is reflected in the "high expectations" some have of residents (i.e. I hate my job and I'll feel better if I take it out on the residents).

Or:

3. The attitude you described above shines through clearly in your work, which makes you miserable to work with.

Some of us love general IM. My advice to my residents is that whatever field they pick, you have to find some enjoyment out of the worst part of the job.

 

[unleash500]

Honestly, no. I don't think you're in trouble. As a fellow Neurology resident and someone who has been in my PD's office before for my evals on IM months (and is moving onto PGY-2 of Neurology), some IM attendings are god-awful, and seem to target non-IM residents more than others. There are 2 reasons for this.

1. They are bigoted toward you because you're not an IM resident and perceive anything you do worse than they would an IM resident;

2. IM really blows, not only because it's a dumping ground for crap no one else wants to deal with, but also because it's where most social work garbage ends up, and the problems the patients have tend to be extraordinarily boring, tedious, and numerous. Because of this, the residents and attendings alike are miserable unless there's something better on the horizon (i.e. fellowship). This is reflected in the "high expectations" some have of residents (i.e. I hate my job and I'll feel better if I take it out on the residents).

I'm not saying Neurology doesn't have its boring stuff/bad consults (altered mental status, head pain, etc.), but it seems like this stuff makes up most of IM, and whatever is more interesting ends up getting consults.

2. I am in IM and I really love it so I don't think it is fair to make a general statement like that. I think it is a great field to go into for the right personality. I really could not see myself in a diff specialty and would choose IM 100% again. Also the hospital I train at really protects residents from being "dumped on" so that is not necessarily true across all hospitals.

 

[NeurologyHopeful2018]

Or:

3. The attitude you described above shines through clearly in your work, which makes you miserable to work with.

Some of us love general IM. My advice to my residents is that whatever field they pick, you have to find some enjoyment out of the worst part of the job.

You and IonClaws are both correct....

There are a good amount of IM residents who both love IM and hate IM. I think its absurd to have us med students choose a specialty after 3 years, and many of us don't really know what they want to do - so they go into IM because it opens alot of doors. Only to realize the misery of being a primary care hospitalist.

 

[cyanide12345678]

You should most likely be fine. I mean a good 49.9 percent of the world has to be below average. Everyone can't be average or above average. One below average evaluation while the remaining are strong evaluations isn't a big deal. In my 3 years as a resident, I've had 2 below average evaluation, maybe 100+ above average ones. The below average ones didn't end up meaning a thing. Some evaluators are tough and only star residents can impress them and the pd knows it.