Anesthesia residency situation. Please help

[anesthesia1567]

I am currently an anesthesia resident in a malignant program. I have tried multiple times to get feedback from PD and staff but all have been very vague with nonspecific complaints. PD has told me to to really consider switching specialities. However, I am in still in good standing. I am very passionate and committed to anesthesia with plans of pursing a Pain fellowship. I am trying my best not to let this situation deter me. Ideally, I would like to switch anesthesia residency programs (and I know of an open spot), but I understand it is difficult to do so without my program's LOR (which I am afraid she will not be willing to write).

My other option is to do PM&R and hope I can get into a Pain fellowship. I know my last option is to tough it out and continue in this program, but I am afraid I will not get a letter from my current PD when the time comes to apply to Pain fellowship. I am not sure what to do in this situation and what the odds are that my PD would be willing to write a LOR for this open anesthesia spot given that I would also be happier being closer to family. Thanks for all your help in advance. I really appreciate it.

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[Twiggidy]

What year are you?

Here's something to know, it is very very VERY hard to fire a resident. Short of premeditated murder of a patient, I may make an argument that a resident almost never gets fired for "general complaints". Trust me, alot of my attendings couldn't stand me for many reasons I won't share here.

Here's where I'll give you some advice.

1. Grind it out, especially if you're heading to CA2/CA3 year. Show up early, say yes sir/no sir and yes ma'am/no ma'am, and do EVERYTHING people tell you. Kill them with kindness. Read everything for you case/topic. Essentially strive to be what you think is the best resident you can be. No one can hate a punctual, hard working resident that is trying hard. Do go off the cuff and think you know everything just do what they tell you.

2. Make absolute best friends with your pain service. When a pain attending is working in the OR ask if you can work with that attending. Strive to be a gold star pain resident. The thing is, when you're applying for pain fellowships, those will be the letters they care about, no a letter from "Joe OR attending". Chairmen and PD tend to write form letters so if your PD wants to write you a transfer letter that is "good" tell he/she to save it for your pain application.

Again, the OR people at my residency didn't like me CA1 year but they couldn't say much because unlike some of my colleagues I was ON TIME (or early), I worked hard on my technique, and I absorbed everything they told me to do. If the said, intubate standing on your head, I did it then said, "now what sir". What can they say, " I can't stand this dude because he's always here, works hard, and does what I say?" I'll take that resident. If it's personality problems, then just don't talk to anyone. I made absolute best friends with my cardiac attendings (who tend to work as a satellite of the main OR) so when I applied to cardiac they took me under their wing and I worked even harder with them. With the OR attg I gave them what they wanted. With the cardiac, I gave them that and more. The next year I was a cardiac fellow and the main OR people who once hated couldn't say a damn thing to me, and heck, were even asking me for help sometimes. Do the same with your pain attendings.

Again, yes sir, no sir, thank you sir. Don't be late....as a matter of fact always be early. If you get a 30 min break, come back in 25. If they ask why, say, "I'm good sir. Grind it out and don't kill anyone. Most residency programs need bodies and it doesn't help them to get rid of one.

 

[amyl]

you could frame it like I think I would be more successful at xyz program in xyz city where I have a better support system.... you could try that. however, I am now going to say something that may be unpopular. if your PD says you are not cut out for anesthesia then you probably aren't. they see hundred of residents, they know what they are talking about. I, myself, work with some residents who are plenty smart and hard working but they just don't get it, their brains don't work like anesthesiologists. Occasionally I work with staff that I think the same thing about.... anesthesia is a weird field that requires intelligence, team player-ness, the ability to deal with the crazy dynamics of the OR, surgeons, nurses, patients, effectively. it requires the type of person who keeps their cool when sh-- hits the fan not run around in circles freaking out. the mindset difference between anesthesia and medicine is very different. one isn't harder or easier, its just different, with different approaches.
maybe switching to PMR is better if you are early on which I suspect you are.... end of ca1? that's about the time that I feel like residents either take to anesthesia or don't.
now, my program felt like this about a few people... they are still anesthesiologists because its true it is hard to fire a resident. that said almost all of these people are not board certified.... writtens are straightforward but the oral is a problem for all these people. good luck

 

[RussianJoo]

Actually it's not that hard to fire a resident. We just fired a CA-2 resident, basically a combination of poor ITE scores, being previously on probation, not feeling comfortable letting the resident do CA-2 level cases, numerous complaints from circulating RN's, PACU RN's and anesthesia attendings stating that the resident is inattentive, doesn't show urgency in treating the patient, doesn't pay attention to vital signs in the OR and just general cluelessness. Even after multiple chief residents, and attendings have talked to this resident he still didn't get it. Every time someone told this resident that he needs to pay closer attention to the patient or that he's doing a basic procedure like placing an A-line the wrong way he would claim that no one has talked to him about this issue before or that no one has taught him how to do this procedure.


My advice to you is that if the program director is telling you, you're not suited or anesthesia chances are they don't feel comfortable graduating you and probably won't. They'll extend your residency, or continue to give you poor evaluations, make you fail rotations and redo them until you resign or get fired. However if you want to do pain medicine ultimately, and don't care about anesthesia. Then chances are pretty good that your program director will write a good letter of rec to allow you to do another residency that's more relaxed and doesn't require such quick actions and working under pressure/stress that will allow you to reach your ultimate goal of being a pain doctor. You should ask your program director why he doesn't think you're cut out for anesthesia and what steps you can take to change this. Most program directors no matter how malignant still want their residents to succeed. If you're not cut out for the fast paced high stress environment of anesthesia then maybe anesthesia is just not for you and PM&R might be a much better choice and your program director will help you get there if he/she believes that you're a better fit for that specialty.

 

[Twiggidy]

Actually it's not that hard to fire a resident. We just fired a CA-2 resident, basically a combination of poor ITE scores, being previously on probation, not feeling comfortable letting the resident do CA-2 level cases, numerous complaints from circulating RN's, PACU RN's and anesthesia attendings stating that the resident is inattentive, doesn't show urgency in treating the patient, doesn't pay attention to vital signs in the OR and just general cluelessness. Even after multiple chief residents, and attendings have talked to this resident he still didn't get it. Every time someone told this resident that he needs to pay closer attention to the patient or that he's doing a basic procedure like placing an A-line the wrong way he would claim that no one has talked to him about this issue before or that no one has taught him how to do this procedure.


My advice to you is that if the program director is telling you, you're not suited or anesthesia chances are they don't feel comfortable graduating you and probably won't. They'll extend your residency, or continue to give you poor evaluations, make you fail rotations and redo them until you resign or get fired. However if you want to do pain medicine ultimately, and don't care about anesthesia. Then chances are pretty good that your program director will write a good letter of rec to allow you to do another residency that's more relaxed and doesn't require such quick actions and working under pressure/stress that will allow you to reach your ultimate goal of being a pain doctor. You should ask your program director why he doesn't think you're cut out for anesthesia and what steps you can take to change this. Most program directors no matter how malignant still want their residents to succeed. If you're not cut out for the fast paced high stress environment of anesthesia then maybe anesthesia is just not for you and PM&R might be a much better choice and your program director will help you get there if he/she believes that you're a better fit for that specialty.

I mean, yeah, if the OP is as you described in you first paragraph, the it wouldn't be terribly hard to get rid of said resident. But OP said many complaints were vague and the fact that as a resident he/she is seeking feedback speaks volumes about willingness to get better. So yes, more details are needed. It's true, a complete was of a resident can be fired....a resident with a few "bumps" can be smoothed out.