- Joined
- Nov 27, 2019
- Messages
- 11
- Reaction score
- 25
Hi-- I am reaching out today after months of uncertainties and ultimately running out of any resources/outlets to provide any advice or guidance. I will try my best to keep this short but feel free to ask about any missing info/details as I don't have any intentions to hide anything. I am an American medical graduate currently in my PGY-2 year in a Psychiatry program. I passed Step 1 and Step 2 on first attempt and was in good standing throughout college and medical school (no disciplinary issues/ no failed clinical rotations) and matched at my top choice for residency programs.
Residency started off great with my first three clinical rotations ending with great evaluations from both attendings and peers. My 4th rotation, however, was an off-service internal medicine rotation at the VA and on Day 1 I knew it would be a challenge. I take full responsibility of my shortcomings this month including: disorganized and inefficient presentations/ general lack of medical knowledge (hadn't done IM since my 3rd year in med school)/ three occasions when I was the last to show up in the morning (leading to more disorganization.) However, my upper-level resident (a PGY-2) throughout this month made the environment even more uncomfortable, but as a new resident, I just assumed this was the culture of residency. Looking back, I do think his constant cursing at female nursing and social work staff and racially-inspired remarks ("Why did you choose to go into medicine when you could have worked at your dad's liquor store?"- I'm of SE Asian descent and this is a stereotype) made it even more tough to have any confidence in my work. Halfway through the month, I spoke with my PGY-2 resident to see what changes I could make and the last ~10 days of the rotation went smoothly.
However, after this rotation ended-- I voluntarily reached out to our Assistant Program Director and spoke with her about what I can do to "redeem" myself, as I fully expected to receive negative evaluations. Turned out I was correct-- my PGY-2 resident submitted an evaluation after my first 2 weeks into the rotation with remarks including "Resident is late/ unorganized/ questionable if she is pre-rounding on patients based on her presentations/ lack of medical knowledge/ resident is unavailable). His evaluation from this rotation encouraged me to make sure these things were corrected for my next internal medicine rotation. Additionally, his evaluation was submitted half-way through the rotation and he never submitted an updated evaluation after the conclusion of the rotation.
A few weeks later, my program director asked to meet with me about this negative evaluation and I assured him that I take full responsibility and that my current rotation was the complete opposite and going great.
Four rotations went by and my evaluations continued to be great. In April, I had my second internal medicine rotation and, this time, my PGY-2 upper level resident was a huge support system and I started the rotation telling him about how my first IM rotation went and how I would appreciate on-the-spot feedback throughout the rotation. I got through this rotation and did not have any problems and moved on to my next rotation. However, about a month later-- one of my IM attendings submitted an evaluation into the system (we did not meet for "feedback" or review at the end of the rotation) that noted 2 issues on the rotation, the first: she reported that on one afternoon, she asked me to see a patient (who was deteriorating and, unfortunately, passed away) and she is not sure if I did based on my report the next morning and the second: working on "closed loop communication" with consults. I was shocked to see the first issue, as not only did I see the patient, I also brought my medical student to see the patient and have text messages to my attending from that evening about the patient's condition and any changes in the plan she wanted to make. I reached out to this attending after reading this evaluation to set up a time to discuss these critiques and to clear any misunderstandings or miscommunication-- we went back and forth on finding a date that would work with us but ultimately did not end up meeting up.
My program director called me into his office again-- this time, to discuss this negative feedback and how he was seeing a "pattern" in these two negative evaluations. I tried to assure my PD that there must have been some miscommunication and that my attending never approached me about this during the rotation about this and, rather, gave positive reinforcement throughout the rotation. Additionally, my rotations before and after this rotation had great evaluations.
At this point, I felt like I was under a microscope for the next few rotations. I was hypervigilant about making a mistake and felt like any mistake or misstep would be reported immediately to my PD. I did a good job at concealing it for a few months-- however, during the first two rotations of my PGY-2 year, it had caught up with me and my anxious-nervousness definitely took away from my confidence and I was making errors because of it (taking on too many patients to prove myself/ ordering a wrong lab/ calling a patient by the wrong name after because the patient was switched overnight/ leaving details out of the plans in patient notes.) Additionally, I previously scheduled to take Step 3 one of my inpatient rotations-- but shortly after meeting with my PD-- I decided to delay it to my "night float" month a few months later due to not wanting to ask for time off soon to take this exam from an inpatient rotation/ not wanting my PD to think anything of it. Ultimately, this was a bad decision and taking a board exam during nightfloat was not setting me up for success-- I failed Step 3 (but re-took it within the next 3 months and passed!)
Two months into my PGY-2 year, my PD calls me into his office. Though there were about 10 positive evaluations from attendings that believed I was doing well, we focused on negative comments. I asked my program director which evaluations he was referring to and where this "pattern" was being seen-- and he reported that these evaluations are not documented, rather, they are comments that reached his desk through different platforms (word-of-mouth/ e-mails). When I asked for examples or which rotation they were referring to, my PD would make vague blanket statements regarding a pattern he was seeing and a "wealth of negative evaluations" that are not in the system that he could not share with me or show me. Because I am a very timid and shy person, I usually just "put my head down" and say yes sir and take responsibility. However, at one point, my PD accused me of being dishonest and that is when I defended myself, as I have never tried to deceive or be dishonest and was not going to accept being told I was. As soon as I started to show my PD the "paper trail" that would exonerate me from any accusation of dishonesty, he immediately got frustrated and told me not to return to my clinical rotation tomorrow and that starting tomorrow I would be on a "reading elective." At this time, my PD asked me if there was anything going on personally that would be affecting my performance and, though it was painful to reveal personal issues to someone I do not know personally, I did disclose what I was going through personally at this time.
I was started on the "reading elective" on September 1st. The only direction I was given from my PD was to "get therapy" (at our hospital's Employee Assistance Program) and to meet a faculty advisor weekly. I also was told to study for our inservice exam and to re-take Step 3. Shortly after, I re-took Step 3 and passed this time. I started therapy and changed my medication regimen for ADHD (I have been diagnosed and started medication in medical school).
The month of September passes and towards the end of every month my scheduling chief would report that she has "gotten no word" on whether I am back on schedule. Every two-three weeks, I would email my PD to give him an "update" and "check-in" regarding returning to clinical duties. I would get a vague response in an e-mail and my PD tells me that it would be best if I went through "Fitness for duty" testing with a forensic neuropsychologist to give them a better idea of what direction to go-- this FFD testing was completed by a professional that my PD knows well and who used to work for the hospital. I was told to be patient, continue therapy, continue meeting with my faculty advisor, and he would arrange for the FFD testing. September passed by, October passes by, November passes, and in December-- I finally meet with my PD and GME Director and we set up a plan for formal remediation: we sign a contract that includes completing the FFD testing, getting back on clinical rotations and highlighted the areas that would need to be performed and excelled at during this remediation time. I finally complete four days worth of FFD testing which included a full interview of early childhood/ adolescent years/ college/ medical school performance, as well as a myriad of personality testing, depression screenings, ADHD screening, and multiple cognitive exams. At the end of the testing, the evaluator reviewed the recommendations she made and we discussed certain goals and changes I could make, as well as accommodations I think would help in the clinical setting.
After receiving the recommendations, I made sure I started on each one of them to further show my program that I was determined to be back on service-- including paying for a ADHD therapist/ coach to meet with weekly, evaluation by a sleep specialist in case sleep was an issue, continuing to meet with my faculty advisor, continuing personal therapy, and working on my clinical knowledge. During this time, however, despite multiple requests via e-mail to meet with my PD to see when the formal remediation would begin/ return to clinical duties (as the FFD was complete and Step 3 was passed)-- I receive vague responses that the program is "working to meet with GME." During this time, I also reached out to my previous attendings from the off service rotations to see if maybe they were the source of "extra evaluations" that are not documented in the system and they all denied any contact with my PD or program.
December goes by, January goes by, and in mid-February, I finally get a less vague response from my program director. I get a long email from my PD saying I will not be returning to clinical duties because "the FFD confirmed our previous concerns and that nothing would change if I was given the chance to remediate in the clinical setting." As you can imagine, after all these months of being isolated without a formal plan and uncertainties, this e-mail crushed me. I called my program director and asked how this decision was made and on what basis and my program director asked why I was so surprised and that "I must have seen this coming"-- this is the opposite of what I believed was coming due to affirmations from my chief residents and from my faculty advisor that the program was working out details and being patient would be the best way to handle this situation. My PD apologized for the 7 months of uncertainty and reported that "it would be in my best interest to leave residency due to medical reasons or to apply for FMLA/ disability and take time off to take care of myself." At this point, I am very confused because the purpose of the last few months was to "work on myself." My PD tells me he feels "uncomfortable" releasing the FFD to me-- and rather, he would prefer to release it to a clinician, i.e. my psychiatrist. A week or two later, I review the FFD with my psychiatrist and speak to the evaluator to see where it was implied that changes could not be made-- she reported she did not make such claims but it was up to the program to interpret the findings from the FFD. The FFD basically showed that the testing revealed I truly do have ADHD, had an above average IQ, remote and distant memory and the two areas that were lacking were "visuo-tactile response time and auditory-visual response time." Interestingly enough, the FFD included only the evaluations in the computer system (that we all have access to" and the only two collateral interviews that were completed were from my program director (who I have NEVER worked with clinically) and one other attending.
Soon after, I meet with the GME director and my PD. Again, I ask my PD if I could have more clarification as to how this decision was made and what allegations/ what data supports this. My GME director (who is not in our department/ relying solely on the info provided by my PD) suggests that a unilateral decision cannot be made-- and that my PD must meet with the clinical competency committee and we will reconvene our meeting in two weeks. At the next meeting, my PD plainly reports that the "CCC has decided to not renew my contract" and reports that he thinks it would be in my best interest to apply for disability and "take time off to care for myself." The GME director says that we will reconvene in another week after I have enough time to look over disability paperwork and "options for moving forward will be discussed at the next meeting." During this meeting, I told my PD I have been meeting with previous attendings and peers to see what possible extra/hidden evaluations are out there and uncovered nothing-- to which I received a vague umbrella answer that "there was enough data to make this decision." My PD also stated that "it would be fruitless and an unproductive use of my time" to submit an Appeal to the GME Grievances committee because patient safety is the main concern. Also, my GME director has repeatedly stated during our meetings that "this is not disciplinary action" and that there is no question of being "terminated".
At this time, I feel extremely lost. I spoke with multiple attorneys who have advised me to not sign any disability paperwork, as there has been no trauma/ new injury that would cause me to be incapable of working and I have been receiving all the recommended treatment for ADHD (both medication management, therapy, etc.) I also met with another forensic neurocognitive psychologist (NOT affiliated with the hospital) and asked him to review the FFD and recommend any further cognitive testing (because at this point, I am starting to believe that maybe I truly do need to look further into this.) This neurocog psychologist actually laughed out loud and stated that there was absolutely no indication for any cognitive testing and stated that, after reviewing the FFD, he has some major concerns about the validity of the tests given, as well as the FFD being very inconclusive and leaving a lot of discretion for the reader to make assumptions.
At this point, I do not know what to do. I am meeting with GME and my program director tomorrow and do not know how to proceed. I am almost positive that if I refuse to sign paperwork claiming that I am disabled, they will terminate me on the spot (or I can resign, whichever.) Does anyone have any guidance?
Lastly, I am not denying that I struggled during some rotations. I just wish I was told during the problem rotations of what was being perceived as deficient to give me the opportunity to make changes.
Residency started off great with my first three clinical rotations ending with great evaluations from both attendings and peers. My 4th rotation, however, was an off-service internal medicine rotation at the VA and on Day 1 I knew it would be a challenge. I take full responsibility of my shortcomings this month including: disorganized and inefficient presentations/ general lack of medical knowledge (hadn't done IM since my 3rd year in med school)/ three occasions when I was the last to show up in the morning (leading to more disorganization.) However, my upper-level resident (a PGY-2) throughout this month made the environment even more uncomfortable, but as a new resident, I just assumed this was the culture of residency. Looking back, I do think his constant cursing at female nursing and social work staff and racially-inspired remarks ("Why did you choose to go into medicine when you could have worked at your dad's liquor store?"- I'm of SE Asian descent and this is a stereotype) made it even more tough to have any confidence in my work. Halfway through the month, I spoke with my PGY-2 resident to see what changes I could make and the last ~10 days of the rotation went smoothly.
However, after this rotation ended-- I voluntarily reached out to our Assistant Program Director and spoke with her about what I can do to "redeem" myself, as I fully expected to receive negative evaluations. Turned out I was correct-- my PGY-2 resident submitted an evaluation after my first 2 weeks into the rotation with remarks including "Resident is late/ unorganized/ questionable if she is pre-rounding on patients based on her presentations/ lack of medical knowledge/ resident is unavailable). His evaluation from this rotation encouraged me to make sure these things were corrected for my next internal medicine rotation. Additionally, his evaluation was submitted half-way through the rotation and he never submitted an updated evaluation after the conclusion of the rotation.
A few weeks later, my program director asked to meet with me about this negative evaluation and I assured him that I take full responsibility and that my current rotation was the complete opposite and going great.
Four rotations went by and my evaluations continued to be great. In April, I had my second internal medicine rotation and, this time, my PGY-2 upper level resident was a huge support system and I started the rotation telling him about how my first IM rotation went and how I would appreciate on-the-spot feedback throughout the rotation. I got through this rotation and did not have any problems and moved on to my next rotation. However, about a month later-- one of my IM attendings submitted an evaluation into the system (we did not meet for "feedback" or review at the end of the rotation) that noted 2 issues on the rotation, the first: she reported that on one afternoon, she asked me to see a patient (who was deteriorating and, unfortunately, passed away) and she is not sure if I did based on my report the next morning and the second: working on "closed loop communication" with consults. I was shocked to see the first issue, as not only did I see the patient, I also brought my medical student to see the patient and have text messages to my attending from that evening about the patient's condition and any changes in the plan she wanted to make. I reached out to this attending after reading this evaluation to set up a time to discuss these critiques and to clear any misunderstandings or miscommunication-- we went back and forth on finding a date that would work with us but ultimately did not end up meeting up.
My program director called me into his office again-- this time, to discuss this negative feedback and how he was seeing a "pattern" in these two negative evaluations. I tried to assure my PD that there must have been some miscommunication and that my attending never approached me about this during the rotation about this and, rather, gave positive reinforcement throughout the rotation. Additionally, my rotations before and after this rotation had great evaluations.
At this point, I felt like I was under a microscope for the next few rotations. I was hypervigilant about making a mistake and felt like any mistake or misstep would be reported immediately to my PD. I did a good job at concealing it for a few months-- however, during the first two rotations of my PGY-2 year, it had caught up with me and my anxious-nervousness definitely took away from my confidence and I was making errors because of it (taking on too many patients to prove myself/ ordering a wrong lab/ calling a patient by the wrong name after because the patient was switched overnight/ leaving details out of the plans in patient notes.) Additionally, I previously scheduled to take Step 3 one of my inpatient rotations-- but shortly after meeting with my PD-- I decided to delay it to my "night float" month a few months later due to not wanting to ask for time off soon to take this exam from an inpatient rotation/ not wanting my PD to think anything of it. Ultimately, this was a bad decision and taking a board exam during nightfloat was not setting me up for success-- I failed Step 3 (but re-took it within the next 3 months and passed!)
Two months into my PGY-2 year, my PD calls me into his office. Though there were about 10 positive evaluations from attendings that believed I was doing well, we focused on negative comments. I asked my program director which evaluations he was referring to and where this "pattern" was being seen-- and he reported that these evaluations are not documented, rather, they are comments that reached his desk through different platforms (word-of-mouth/ e-mails). When I asked for examples or which rotation they were referring to, my PD would make vague blanket statements regarding a pattern he was seeing and a "wealth of negative evaluations" that are not in the system that he could not share with me or show me. Because I am a very timid and shy person, I usually just "put my head down" and say yes sir and take responsibility. However, at one point, my PD accused me of being dishonest and that is when I defended myself, as I have never tried to deceive or be dishonest and was not going to accept being told I was. As soon as I started to show my PD the "paper trail" that would exonerate me from any accusation of dishonesty, he immediately got frustrated and told me not to return to my clinical rotation tomorrow and that starting tomorrow I would be on a "reading elective." At this time, my PD asked me if there was anything going on personally that would be affecting my performance and, though it was painful to reveal personal issues to someone I do not know personally, I did disclose what I was going through personally at this time.
I was started on the "reading elective" on September 1st. The only direction I was given from my PD was to "get therapy" (at our hospital's Employee Assistance Program) and to meet a faculty advisor weekly. I also was told to study for our inservice exam and to re-take Step 3. Shortly after, I re-took Step 3 and passed this time. I started therapy and changed my medication regimen for ADHD (I have been diagnosed and started medication in medical school).
The month of September passes and towards the end of every month my scheduling chief would report that she has "gotten no word" on whether I am back on schedule. Every two-three weeks, I would email my PD to give him an "update" and "check-in" regarding returning to clinical duties. I would get a vague response in an e-mail and my PD tells me that it would be best if I went through "Fitness for duty" testing with a forensic neuropsychologist to give them a better idea of what direction to go-- this FFD testing was completed by a professional that my PD knows well and who used to work for the hospital. I was told to be patient, continue therapy, continue meeting with my faculty advisor, and he would arrange for the FFD testing. September passed by, October passes by, November passes, and in December-- I finally meet with my PD and GME Director and we set up a plan for formal remediation: we sign a contract that includes completing the FFD testing, getting back on clinical rotations and highlighted the areas that would need to be performed and excelled at during this remediation time. I finally complete four days worth of FFD testing which included a full interview of early childhood/ adolescent years/ college/ medical school performance, as well as a myriad of personality testing, depression screenings, ADHD screening, and multiple cognitive exams. At the end of the testing, the evaluator reviewed the recommendations she made and we discussed certain goals and changes I could make, as well as accommodations I think would help in the clinical setting.
After receiving the recommendations, I made sure I started on each one of them to further show my program that I was determined to be back on service-- including paying for a ADHD therapist/ coach to meet with weekly, evaluation by a sleep specialist in case sleep was an issue, continuing to meet with my faculty advisor, continuing personal therapy, and working on my clinical knowledge. During this time, however, despite multiple requests via e-mail to meet with my PD to see when the formal remediation would begin/ return to clinical duties (as the FFD was complete and Step 3 was passed)-- I receive vague responses that the program is "working to meet with GME." During this time, I also reached out to my previous attendings from the off service rotations to see if maybe they were the source of "extra evaluations" that are not documented in the system and they all denied any contact with my PD or program.
December goes by, January goes by, and in mid-February, I finally get a less vague response from my program director. I get a long email from my PD saying I will not be returning to clinical duties because "the FFD confirmed our previous concerns and that nothing would change if I was given the chance to remediate in the clinical setting." As you can imagine, after all these months of being isolated without a formal plan and uncertainties, this e-mail crushed me. I called my program director and asked how this decision was made and on what basis and my program director asked why I was so surprised and that "I must have seen this coming"-- this is the opposite of what I believed was coming due to affirmations from my chief residents and from my faculty advisor that the program was working out details and being patient would be the best way to handle this situation. My PD apologized for the 7 months of uncertainty and reported that "it would be in my best interest to leave residency due to medical reasons or to apply for FMLA/ disability and take time off to take care of myself." At this point, I am very confused because the purpose of the last few months was to "work on myself." My PD tells me he feels "uncomfortable" releasing the FFD to me-- and rather, he would prefer to release it to a clinician, i.e. my psychiatrist. A week or two later, I review the FFD with my psychiatrist and speak to the evaluator to see where it was implied that changes could not be made-- she reported she did not make such claims but it was up to the program to interpret the findings from the FFD. The FFD basically showed that the testing revealed I truly do have ADHD, had an above average IQ, remote and distant memory and the two areas that were lacking were "visuo-tactile response time and auditory-visual response time." Interestingly enough, the FFD included only the evaluations in the computer system (that we all have access to" and the only two collateral interviews that were completed were from my program director (who I have NEVER worked with clinically) and one other attending.
Soon after, I meet with the GME director and my PD. Again, I ask my PD if I could have more clarification as to how this decision was made and what allegations/ what data supports this. My GME director (who is not in our department/ relying solely on the info provided by my PD) suggests that a unilateral decision cannot be made-- and that my PD must meet with the clinical competency committee and we will reconvene our meeting in two weeks. At the next meeting, my PD plainly reports that the "CCC has decided to not renew my contract" and reports that he thinks it would be in my best interest to apply for disability and "take time off to care for myself." The GME director says that we will reconvene in another week after I have enough time to look over disability paperwork and "options for moving forward will be discussed at the next meeting." During this meeting, I told my PD I have been meeting with previous attendings and peers to see what possible extra/hidden evaluations are out there and uncovered nothing-- to which I received a vague umbrella answer that "there was enough data to make this decision." My PD also stated that "it would be fruitless and an unproductive use of my time" to submit an Appeal to the GME Grievances committee because patient safety is the main concern. Also, my GME director has repeatedly stated during our meetings that "this is not disciplinary action" and that there is no question of being "terminated".
At this time, I feel extremely lost. I spoke with multiple attorneys who have advised me to not sign any disability paperwork, as there has been no trauma/ new injury that would cause me to be incapable of working and I have been receiving all the recommended treatment for ADHD (both medication management, therapy, etc.) I also met with another forensic neurocognitive psychologist (NOT affiliated with the hospital) and asked him to review the FFD and recommend any further cognitive testing (because at this point, I am starting to believe that maybe I truly do need to look further into this.) This neurocog psychologist actually laughed out loud and stated that there was absolutely no indication for any cognitive testing and stated that, after reviewing the FFD, he has some major concerns about the validity of the tests given, as well as the FFD being very inconclusive and leaving a lot of discretion for the reader to make assumptions.
At this point, I do not know what to do. I am meeting with GME and my program director tomorrow and do not know how to proceed. I am almost positive that if I refuse to sign paperwork claiming that I am disabled, they will terminate me on the spot (or I can resign, whichever.) Does anyone have any guidance?
Lastly, I am not denying that I struggled during some rotations. I just wish I was told during the problem rotations of what was being perceived as deficient to give me the opportunity to make changes.
Last edited:
Thank you!
