Finding out what programs will fire residents?

[KanyeWes]

I go to a med school that has fired many residents. But I only found this out because the residents gossip. How can I find this out when I am on the interview trail? Of course, I would never ask on the interview trail as that would put a target on my back. But I don't want to match into a program that routine fires residents like my med school does.

Are there any dead give aways that would clue me in other than looking at their roster? Any advice would help.

My attendings have said that they don't think that I would be a problem resident, which I would agree as I would never actively cause issues. But I understand things do happen. I have seen things blow up in resident's faces where the resident didn't actively start fights.

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[Winged Scapula]

Let's start with the basics.

Are there really "many residents" fired, more than the average?

What were the reasons for firing? Despite the conventional SDN "wisdom", residents are rarely fired willy-nilly or for "starting fights".

 

[KanyeWes]

Let's start with the basics.

Are there really "many residents" fired, more than the average?

What were the reasons for firing? Despite the conventional SDN "wisdom", residents are rarely fired willy-nilly or for "starting fights".

I heard that they were awful residents. I don't know the specifics, but firing 5%+ over multiple years across multiple specialties is just fishy to me. Does not sound right to me, but I am still a med student...so what do I know?

 

[Winged Scapula]

I heard that they were awful residents. I don't know the specifics, but firing 5%+ over multiple years across multiple specialties is just fishy to me. Does not sound right to me, but I am still a med student...so what do I know?

So if they were "awful residents", what do you have to worry about especially since you didn't seem to indicate you were staying at your home program? Perhaps they deserved to be fired.

But at any rate, 5% over multiple years doesn't sound ridiculously high to me, especially if you include those who left of their own accord.

I would caution you to listen to idle resident gossip; its likely they don't know the real reasons for everyone's departure.

 

[KanyeWes]

So if they were "awful residents", what do you have to worry about especially since you didn't seem to indicate you were staying at your home program? Perhaps they deserved to be fired.

But at any rate, 5% over multiple years doesn't sound ridiculously high to me, especially if you include those who left of their own accord.

I would caution you to listen to idle resident gossip; its likely they don't know the real reasons for everyone's departure.

I am concerned about the actions that my deans have made to get rid of med students. That paired with the resident attrition rate at my school is concerning for me. I almost suffer PTSD and don't want to find myself in this situation again. No one wants to get rid of me, but that is due to me keeping my mouth shut. Of course I have concerns that I may only match at my home program, which would be awful.

 

[Winged Scapula]

I am concerned about the actions that my deans have made to get rid of med students. That paired with the resident attrition rate at my school is concerning for me. I almost suffer PTSD and don't want to find myself in this situation again. No one wants to get rid of me, but that is due to me keeping my mouth shut. Of course I have concerns that I may only match at my home program, which would be awful.

Unless there's something you're not telling us, you're being paranoid.

The number of students and residents that are fired without cause approaches zero. As a student if you pass your courses, do well on your board examinations and aren't a sociopath/felon/substance abuser etc, you aren't going to get fired. The same goes for residents.

 

[KanyeWes]

Unless there's something you're not telling us, you're being paranoid.

The number of students and residents that are fired without cause approaches zero. As a student if you pass your courses, do well on your board examinations and aren't a sociopath/felon/substance abuser etc, you aren't going to get fired. The same goes for residents.

I struggled with grades during M1/2. Those issues are rectified now and I am doing well in M3 (top 1/3 or 1/4). It's a story that I hear is not uncommon. Hence my paranoia. Due to my poor grades, I am concerned that I can only match into bad programs that have kicked residents out. Or worst yet...match into my home program...

 

[Winged Scapula]

I struggled with grades during M1/2. Those issues are rectified now and I am doing well in M3 (top 1/3 or 1/4). It's a story that I hear is not uncommon. Hence my paranoia. Due to my poor grades, I am concerned that I can only match into bad programs that have kicked residents out. Or worst yet...match into my home program...

No one cares about your grades in M1/M2.

You really need to relax.

 

[KanyeWes]

No one cares about your grades in M1/M2.

You really need to relax.

That's what I tell them too, respectfully of course. I did fail a course but I successfully remediated it. It will show up on my transcript.

My deans are telling me to only apply psyche, FM, peds, and IM and it is an uphill battle whenever I bring up EM anything else.

 

[deleted480308]

That's what I tell them too, respectfully of course.

My deans are telling me to only apply psyche, FM, peds, and IM and it is an uphill battle whenever I bring up EM anything else.

Board scores...

 

[KanyeWes]

Board scores...

That is a key aspect that is missing from this picture. I cannot say as it will make it easier to track me. My school admin sometimes trolls here on SDN.

 

[deleted480308]

That is a key aspect that is missing. I cannot say as it will make it easier to track me. My school admin sometimes trolls here on SDN.

If you're trolling, at least you're intriguing

1) it's not a bad thing for someone to find out you might like EM
2) are your scores competitive for EM?

 

[KanyeWes]

If you're trolling, at least you're intriguing

1) it's not a bad thing for someone to find out you might like EM
2) are your scores competitive for EM?

Feel free to think that I am trolling. I am not. I am really just mixed up due to all the misinformation and half truths from my deans.

I think I can match into EM. They know I want to go into EM. But my deans always paint a grim picture with my poor M1/2 performance, which I don't 100% agree with what they think of my odds of matching. But I am a med student who hasn't been through the entire process...so what I do I really know?

 

[LucidSplash]

Feel free to think that I am trolling. I am not. I am really just mixed up due to all the misinformation and half truths from my deans.

I think I can match into EM. They know I want to go into EM. But my deans always paint a grim picture with my poor M1/2 performance, which I don't 100% agree with what they think of my odds of matching. But I am a med student who hasn't been through the entire process...so what I do I really know?

For more information on this topic, I recommend posting in the WAMC thread in the EM forum. You're likely to get help there. If you don't want to post your stats under your username, you can likely PM one of the mods/active members about it, but you'll need to give them your scores and other info to get good advice.

 

[KanyeWes]

For more information on this topic, I recommend posting in the WAMC thread in the EM forum. You're likely to get help there. If you don't want to post your stats under your username, you can likely PM one of the mods/active members about it, but you'll need to give them your scores and other info to get good advice.

Thanks. I kind of did that already.

I guess back onto the original topic. Are there any signs that I should look for with programs firing residents? Would it be nervous residents that are afraid to speak? Or just going with my gut feeling?

 

[LucidSplash]

Thanks. I kind of did that already.

I guess back onto the original topic. Are there any signs that I should look for with programs firing residents? Would it be nervous residents that are afraid to speak? Or just going with my gut feeling?

You're not going to be able to tell unless they tell you. You can find out some things from other students on the trail with you, who you will see over and over again. But like you, they will only know the rumors/gossip they hear about their own institution so its hard to trust that.

I urge you to pay attention to how the residents interact with each other at the pre-interview event. I always considered it suspicious if very few residents showed up to those events; to me that meant that either they didn't give a crap about who showed up next (and if you're invested in your program you should) or they were too busy to make time, which is another red flag. Then during the event see if the residents have good camraderie. Places with toxic policies and faculty usually don't have good resident camraderie. Everyone is just trying to survive.

 

[LucidSplash]

Additionally, you don't really know if its a bad thing if a resident gets fired. You don't know anything about their situation or the background.

Several years ago, I knew of 2 IM residents who were summarily fired after it was discovered that one was writing the other narcotic scripts on the institutional DEA for residents, in exchange for sexual favors. I'd say that's a pretty good reason to get fired.

So as others have said, you need to relax. If you get a "not right" feel from a place, then pay attention to that. Otherwise there's not going to be any hard data to go on.

 

[KanyeWes]

You're not going to be able to tell unless they tell you. You can find out some things from other students on the trail with you, who you will see over and over again. But like you, they will only know the rumors/gossip they hear about their own institution so its hard to trust that.

I urge you to pay attention to how the residents interact with each other at the pre-interview event. I always considered it suspicious if very few residents showed up to those events; to me that meant that either they didn't give a crap about who showed up next (and if you're invested in your program you should) or they were too busy to make time, which is another red flag. Then during the event see if the residents have good camraderie. Places with toxic policies and faculty usually don't have good resident camraderie. Everyone is just trying to survive.

Thanks for the solid advice. That example is awful, but it makes sense why some people should get automatically fired. Just like that other thread where a resident showed up drunk to operate...

 

[AdmiralChz]

It's actually very difficult to get fired from residency unless you abuse drugs or assault someone. It leaves the residents short as well which means more call for everyone - unpopular to say the least. You can always go to the resident face sheets on the internet and see if the numbers are roughly the same if you really want to go crazy.

You allude to PTSD and your nervousness about past performance frequently. Yes, a bad step 1 can be hard to overcome for competitive fields like EM but not impossible. No one cares what your grade on biochem was, trust me.

On a different note, there are malignant programs out there - my medical school program in my field was one and the residents were miserable, it was readily apparent during the dinner and in just casual conversation with them. So I just ranked other programs higher and matched elsewhere - no one says you have to stay at your med school for residency.

 

[Winged Scapula]

That is a key aspect that is missing from this picture. I cannot say as it will make it easier to track me. My school admin sometimes trolls here on SDN.

I think you mean he/she sometimes trawls here.

You've gotten good advice here; as others have noted, no one cares about your M1/M2 grades. The WAMC thread in EM will give you some information as to your competitiveness and what you need to do/continue to do to match.

 

[KanyeWes]

I think you mean he/she sometimes trawls here.

You've gotten good advice here; as others have noted, no one cares about your M1/M2 grades. The WAMC thread in EM will give you some information as to your competitiveness and what you need to do/continue to do to match.

Thanks everyone. I got what I needed. Feel free to close.

 

[Keona]

Look at the number of residents in each class. If there are less in one class it's a red flag in terms of them leaving, one program I know lost 2 or 3 of their class. It was obvious due to the size of the program I think. some residents will graduate off cycle so sometimes the 3rd year class will seem to have extra compared to the intern class due to time off, etc.

 

[Raryn]

Look at the number of residents in each class. If there are less in one class it's a red flag in terms of them leaving, one program I know lost 2 or 3 of their class. It was obvious due to the size of the program I think. some residents will graduate off cycle so sometimes the 3rd year class will seem to have extra compared to the intern class due to time off, etc.

Lots of people might go off cycle for any number of reasons, it doesn't mean they were fired.

People can quit because they want to change specialties. They can have health issues. They can want to change programs because of family/geographic concerns. Etc.

It's super specialty dependent too: surgical fields tend to have a fair bit of people who realize after a year or two they didn't really want to be surgeons. Most of them aren't fired, they find something else to do. Psychiatry is notorious for having the highest attrition rate of any residency.

 

[Winged Scapula]

Lots of people might go off cycle for any number of reasons, it doesn't mean they were fired.

People can quit because they want to change specialties. They can have health issues. They can want to change programs because of family/geographic concerns. Etc.

It's super specialty dependent too: surgical fields tend to have a fair bit of people who realize after a year or two they didn't really want to be surgeons. Most of them aren't fired, they find something else to do. Psychiatry is notorious for having the highest attrition rate of any residency.

Yep.

In addition in many surgical fields, residents go in and out of the research lab, so there may be varying numbers of residents per year which reflects this.

 

[sazerac]

Lots of people might go off cycle for any number of reasons, it doesn't mean they were fired.

People can quit because they want to change specialties. They can have health issues. They can want to change programs because of family/geographic concerns. Etc.

It's super specialty dependent too: surgical fields tend to have a fair bit of people who realize after a year or two they didn't really want to be surgeons. Most of them aren't fired, they find something else to do. Psychiatry is notorious for having the highest attrition rate of any residency.

Psychiatry has a lot of attrition into fellowship as well. Sometimes half of the 4th years are missing because they fast-tracked into a fellowship. I even saw one program in Texas that had no PGY4's because the entire class went into child psychiatry.

 

[mvenus929]

Look at the number of residents in each class. If there are less in one class it's a red flag in terms of them leaving, one program I know lost 2 or 3 of their class. It was obvious due to the size of the program I think. some residents will graduate off cycle so sometimes the 3rd year class will seem to have extra compared to the intern class due to time off, etc.

My class is 2 people smaller than the rest of the classes that have been around while we've been here. We lost the first person after intern year when she decided to pursue a different specialty. We lost the second after second year for similar reasons. The class above us lost one halfway through third year due to undisclosed reasons. People leave for all sorts of reasons, and just seeing different sizes doesn't tell you the whole story. I think for the most part, our class has been pretty open about the fact that we are down, because it wasn't the fault of the program.

 

[Bryan O’Blivion]

In principle, all residency programs will dismiss residents. Programs that have done so are not necessarily bad. There really are problem residents out there who consistently demonstrate behavior or lack of aptitude such that it would be irresponsible to let them independently practice in that field. In a way, a program that graduates people no matter how inept they are is not very good.

A better question is how do programs arrange removing residents that are not working out? A graceful transition is from a interventional field to a non interventional field, as an example. Does the program help facilitate that, or do they simply cut them loose with a YOYO?

Worth asking on the interview trail, if it is a concern to you.

 

[mimelim]

I think a program's willingness to fire residents is a positive thing. I have seen so many programs hurt because of their unwillingness to cut-loose problem people or allowing them to linger for far too long. I also have yet to see a resident get canned that shouldn't have been.

Certainly anti-malignant programs, but firing residents is not a good marker of anything. Also, 5% attrition? That is low...

 

[Raryn]

I think a program's willingness to fire residents is a positive thing. I have seen so many programs hurt because of their unwillingness to cut-loose problem people or allowing them to linger for far too long. I also have yet to see a resident get canned that shouldn't have been.

Certainly anti-malignant programs, but firing residents is not a good marker of anything. Also, 5% attrition? That is low...

5% is around average for IM and other non-surgical specialties. Gen surg is at 20% and psych is at 25% iirc. The data is a few years old, so I don't know if it's changed.

 

[Light at end of tunnel]

I think a program's willingness to fire residents is a positive thing. I have seen so many programs hurt because of their unwillingness to cut-loose problem people or allowing them to linger for far too long. I also have yet to see a resident get canned that shouldn't have been.

Certainly anti-malignant programs, but firing residents is not a good marker of anything. Also, 5% attrition? That is low...

Aside from the firing/termination of residents, you also will want to look at the number of residents that "transfer" or "resign" from a given program. Making a resident go away quietly is much cleaner and cheaper than a potentially public and attention drawing termination.

 

[WingedOx]

5% is around average for IM and other non-surgical specialties. Gen surg is at 20% and psych is at 25% iirc. The data is a few years old, so I don't know if it's changed.

Admittedly I was at one of the better psych program out there, but I wasn't aware it was so high. Especially considering the tolerance for some seriously iffy personalities I've seen from other programs in my area.

Aside from the firing/termination of residents, you also will want to look at the number of residents that "transfer" or "resign" from a given program. Making a resident go away quietly is much cleaner and cheaper than a potentially public and attention drawing termination.

This is simply bad advice. People came and go for all sorts of reasons, as noted above. The rumors that circulate when someone leaves a program are always really dumb. We had a guy just get up and quit a few weeks into his intern year who completely dropped out of clinical medicine entirely. He was a pretty awful resident when he was here to be honest. For the next year or so the SDN psych boards kept circulating rumors that [wingedox U hospital program] was having problems that were driving residents away.

 

[Light at end of tunnel]

Admittedly I was at one of the better psych program out there, but I wasn't aware it was so high. Especially considering the tolerance for some seriously iffy personalities I've seen from other programs in my area.



This is simply bad advice. People came and go for all sorts of reasons, as noted above. The rumors that circulate when someone leaves a program are always really dumb. We had a guy just get up and quit a few weeks into his intern year who completely dropped out of clinical medicine entirely. He was a pretty awful resident when he was here to be honest. For the next year or so the SDN psych boards kept circulating rumors that [wingedox U hospital program] was having problems that were driving residents away.

It sure would be nice if we could also hear from the resident you "objectively" refer to as "awful."

After all, your perspective on a matter you refer to as rumour is in and of itself rumour bordering on hearsay.

How mighty we are when we accuse others without giving them an opportunity to be heard.

 

[rokshana]

It sure would be nice if we could also hear from the resident you objectively refer to as "awful."

After all, your perspective on a matter you refer to as rumour is in and of itself rumour bordering on hearsay.

How mighty we are when we accuse others without giving them an opportunity to be heard.

actually you mean subjectively, meaning his opinion is part of the assessment...if his assessment is objective, then its based on facts that are not disputable...just sayin'.

 

[clausewitz2]

Admittedly I was at one of the better psych program out there, but I wasn't aware it was so high. Especially considering the tolerance for some seriously iffy personalities I've seen from other programs in my area.



This is simply bad advice. People came and go for all sorts of reasons, as noted above. The rumors that circulate when someone leaves a program are always really dumb. We had a guy just get up and quit a few weeks into his intern year who completely dropped out of clinical medicine entirely. He was a pretty awful resident when he was here to be honest. For the next year or so the SDN psych boards kept circulating rumors that [wingedox U hospital program] was having problems that were driving residents away.

Yeah, but you trained in a fairly desirable part of the country so there was probably still a minimum floor on quality. Surely of the weaksauce psychiatrists that are out there, many of them were weaksauce residents as well.

I am skeptical of 25%, but psych does have a tendency to be the refuge of people who were not so good at school or are not interested in continuing in medicine especially. Not shocked that the rate is high, but also think it is attributable to resident characteristics.

 

[girlofgrace7]

It's not always just hearsay. Residents work together day in and day out and usually know which people are a huge problem to work with. We have two residents in our program of 95-ish who everyone would agree should be fired/not promoted (for the record, I've never known of a single resident at my program who has been fired or not promoted... whether that's good or bad, I'll leave up to you guys). It has nothing to do with "rumors" in many cases.

One is a person who, although very nice and well-meaning, none of us feel comfortable letting take care of patients without oversight due to severe incompetence. Generally, upper levels will put in orders for new admissions or at least have to oversee the interns' new admission orders, but several attendings had to ask him not to place orders as a second and third year because he was putting patients at severe risk (his interns did all the orders by themselves). Whenever one of us are on service with him, we all wind up taking way more patients and all of the complicated ones because he is such a safety concern even with feeder-grower patients (I'm in peds). People have bent over backwards trying to help him (residents, attendings, and program directors), but it scares us all he will be taking care of patients alone if he is not prevented from progressing.

The other is a person who has no work ethic whatsoever. He repetitively oversleeps and calls in jeopardy for everything imaginable (or sometimes doesn't call in and interns will have to call the chiefs when their upper level never shows up). When he does show up, he doesn't do much actual work. If he does work, he usually winds up doing something careless/dangerous; for instance, going to do a procedure alone that he had never done/seen before without informing the attending (or even the patient's nurse) he was doing a procedure on the patient, resulting in patient harm.

Neither of these cases are subtle or debatable. They've both been on probation, but getting fired is very difficult in many programs unless you do something completely egregious. It's not necessarily a good thing. Are there people that struggle or who aren't amazing clinicians? Sure, but these aren't usually the people at danger of not progressing, and I don't feel like people are "blindsided" by being fired since there are usually major issues before. Also, looking at a class composite isn't very accurate... there's always people who decide to switch to a different specialty a year or two in or who take prolonged leave and drop into the class below. Just get a feel for resident camaraderie at the dinners and such. You can get a pretty good gut feeling about malignant programs that way.

 

[Light at end of tunnel]

It's not always just hearsay. Residents work together day in and day out and usually know which people are a huge problem to work with. We have two residents in our program of 95-ish who everyone would agree should be fired/not promoted (for the record, I've never known of a single resident at my program who has been fired or not promoted... whether that's good or bad, I'll leave up to you guys). It has nothing to do with "rumors" in many cases.

One is a person who, although very nice and well-meaning, none of us feel comfortable letting take care of patients without oversight due to severe incompetence. Generally, upper levels will put in orders for new admissions or at least have to oversee the interns' new admission orders, but several attendings had to ask him not to place orders as a second and third year because he was putting patients at severe risk (his interns did all the orders by themselves). Whenever one of us are on service with him, we all wind up taking way more patients and all of the complicated ones because he is such a safety concern even with feeder-grower patients (I'm in peds). People have bent over backwards trying to help him (residents, attendings, and program directors), but it scares us all he will be taking care of patients alone if he is not prevented from progressing.

The other is a person who has no work ethic whatsoever. He repetitively oversleeps and calls in jeopardy for everything imaginable (or sometimes doesn't call in and interns will have to call the chiefs when their upper level never shows up). When he does show up, he doesn't do much actual work. If he does work, he usually winds up doing something careless/dangerous; for instance, going to do a procedure alone that he had never done/seen before without informing the attending (or even the patient's nurse) he was doing a procedure on the patient, resulting in patient harm.

Neither of these cases are subtle or debatable. They've both been on probation, but getting fired is very difficult in many programs unless you do something completely egregious. It's not necessarily a good thing. Are there people that struggle or who aren't amazing clinicians? Sure, but these aren't usually the people at danger of not progressing, and I don't feel like people are "blindsided" by being fired since there are usually major issues before. Also, looking at a class composite isn't very accurate... there's always people who decide to switch to a different specialty a year or two in or who take prolonged leave and drop into the class below. Just get a feel for resident camaraderie at the dinners and such. You can get a pretty good gut feeling about malignant programs that way.

It really sounds like, at least the first resident, as a risk to patients was justfiably put on probation.

Did you work with the residents that wingedox referenced as well or is that an entirely separate matter?

Thanks for the explanation, by the way.

 

[NotAProgDirector]

They've both been on probation, but getting fired is very difficult in many programs unless you do something completely egregious.

Very interesting, thanks for sharing. As a PD, if I'm going to let a resident go, I really want to make sure I'm doing the "right" thing. I've had some residents where early on I'm certain they are not going to make it, and then they surprise me. So I try to approach each situation with an open mind. That said, the situation you're describing is very troubling. One of the worst things I can do as a PD is promote someone who is not ready for it -- it's "impossible" to demote people, and once people are in over their heads, it's hard to stop them from drowning.

Where I run into the biggest difficulty is the non-clinical issues. Take a resident who clinically (i.e. making decisions and providing care) is just fine. But they are hard headed, and get into disagreements with nursing that escalate. They state that the "nurse was wrong", and might be right about that. Often the situation is more complex -- a nurse was following a protocol that didn't make much sense in the clinical scenario, yet was "right" per protocol. How disruptive does a resident need to be before I decide to let them go? Or how unreliable in actually showing up? And what if they show up when on inpatient / call / clinic, but don't show up when "no one is looking"?

Another minefield is the resident who is fine in the outpatient clinic, but struggles on the inpatient rotations. They decide they want an outpatient only career, and we think that they are competent to do so. But graduating from the program and board certification are predicated on competence in all arenas. No easy answers, or if there are some, I haven't found them yet.

 

[Light at end of tunnel]

Sigh. Rings so true with one of my junior residents I'm trying to work with right now.

They approach everything with a very hard-headed, right or wrong view. They also - if they perceive someone else to be less hard working or lazy or incompetent - act in a very outwardly demeaning way toward them...even their co-residents. Clinically the person is smart and does tend to be right in these situations more often than not. But their behavior in those situations is rough, and even after the fact they show little remorse because "they were right".

So what do you do in that particular case?

Does right make might?

 

[ThoracicGuy]

It sure would be nice if we could also hear from the resident you "objectively" refer to as "awful."

After all, your perspective on a matter you refer to as rumour is in and of itself rumour bordering on hearsay.

How mighty we are when we accuse others without giving them an opportunity to be heard.

 

[Domperidone]

It sure would be nice if we could also hear from the resident you "objectively" refer to as "awful."

After all, your perspective on a matter you refer to as rumour is in and of itself rumour bordering on hearsay.

How mighty we are when we accuse others without giving them an opportunity to be heard.

Lol..
giving them an opportunity to be heard. oh most of us do with our struggling "co-residents', we're not all dinguses. I mean, c'mon. Majority of the time, the resident who gets let go had no insight. At least in my experience. Like a slow moving train wreck, it's hard to watch. As much as you try to stop it, it doesn't seem to want to go off it's current track. All you can do..is let it go.

What I used to think as a student is quite different to what I feel now. i can't say that I relied on other students to get through medical school. Sure I had help, but residency..it's just not something you go through alone. We try to be supportive of each other, because at any point in time it could be us that's struggling. A bad day, bad sleep, relationship break up - a lot of very real things can affect the quality of your work and focus. But there's only so far you can go before they start to compromise patient care and your sanity.

A couple of my experiences were similar to girlofgrace7 in post #35 and i ended up with a similar POV as a result.

With the ones (that I knew) that went on probation or just got bad evals, it went two ways with them. Either they gained crucial insight and recovered really well. Are better doctors/residents as a result. Or they didn't. And are no longer working with us. The longer the latter type stayed, the worse it was for everyone around them. It was sad, but that's how it was. Often they were oblivious to the fact that they made everyone's life harder as we were having to do their jobs in addition to ours. What I learned from their example was how not to traumatize your co-residents and alienate the people you work with. While I feel sorry for them, I'm not sorry over the fact that I'll never be seeing them again.

There's a lot on the line, and you'd have to be really blind or have a massive ego to not care enough to change. Or have really bad luck - severe attending, unsupportive co-residents, but one rotation in this scenario wasn't going to necessarily get someone fired or put on probation. Generally, residency is meant to be about learning anyway. I don't think any attending faced with cutting someone's training short (or things along those lines) takes it like lightly.

Don't think of it as a common occurrence by the way, for any students reading this. it's not. I've seen this mentioned in other threads. think of it as a law of statistics, in every group of 10 there's always going to be one freak.

On reading SouthernSurgeon and aProgDirector's posts in #37 & #38 respectively..
I hadn't thought about that before - the non-clinical things becoming bigger issues. I got occasional 'collateral damage' from another co-resident being put under the microscope for their approach. It left me a bit mystified before, as they were exactly what was mentioned above - clinically sound, great to work with, but not flexible about certain issues with nurses. bit defensive. occasionally a bit condescending. whereas the rest of us would just try to go with the flow. I guess those posts explain it now.

Actually they reminded me of Elliot from the first season of Scrubs, just constantly digging their own grave with the nurses.

Anyway OP, I think one of the best answers to what you're looking for is the response by Brick Majors:

A better question is how do programs arrange removing residents that are not working out? A graceful transition is from a interventional field to a non interventional field, as an example. Does the program help facilitate that, or do they simply cut them loose with a YOYO?

Worth asking on the interview trail, if it is a concern to you.

How supportive is the program when a resident gets into trouble (in the event that that's you in the future). Try to think of appropriate ways to probe this. Or just, gauge what your impressions are of the other residents and faculty/program director - do they seem like they'd be supportive, do you fit in with them? Are they people you'd enjoy working with? Will they take care of you when you need them? (People are less likely to give negative feedback on people they like by the way - just human nature) You can always ask the residents if they like their program or would recommend it to future residents. Obviously, don't ask within ear shot of their superiors if you want a more honest answer.
N.b. We tend to gossip more about people who are driving us crazy, just to vent. Admittedly, we shouldn't do it around students. :C

 

[Goro]

Fascinating thread, folks. What's really interesting to me is that from the academics side, it's just as hard to get rid of an incompetent or dysfunctional post-doc as it appears to be to get rid of a similar resident.

Over the past 15 years, I can think of only two who got canned. One was a person with mental health issues, super bright, but like some of the personalities described above, 100% sure of himself, and he would latch onto ideas in almost a OCD manner. He got canned after becoming a major PITA at a symposium, and deliberately disobeyed an order from the head of HR NOT to go back into the auditorium, where the seminar was being held.

The other was a woman from another country, who out and out lied about her skill sets, and when trying to do science, would just screw up one thing after another. She also embellished her English skills; she was practically incomprehensible.

Most other incompetents we simply put up with, until their funding runs out, and they find another lab.

 

[Light at end of tunnel]

Lots of good points. There is one thing that seems to be missing from everyone's posts though: a sense of some responsibility or taking ownership of being part of an environment that gives rise to folks being better off leaving a given program. While it is always easier for everyone left behind to create and release the scapegoat, it may be worthwhile to do some introspection as well.

Students/residents are not perfect, but neither are their current/former programs. If there truly is this underground network where people are shuffled around quietly, then there must be a demand for this arrangement, which again only serves to reinforce the idea that the widespread systematic problem isnt just about residents/students only that it is much easier to get rid of them than it is to change or get rid of the hospital/program.

 

[LucidSplash]

Lots of good points. There is one thing that seems to be missing from everyone's posts though: a sense of some responsibility or taking ownership of being part of an environment that gives rise to folks being better off leaving a given program. While it is always easier for everyone left behind to create and release the scapegoat, it may be worthwhile to do some introspection as well.

Students/residents are not perfect, but neither are their current/former programs. If there truly is this underground network where people are shuffled around quietly, then there must be a demand for this arrangement, which again only serves to reinforce the idea that the widespread systematic problem isnt just about residents/students only that it is much easier to get rid of them than it is to change or get rid of the hospital/program.

I don't agree. It has been noted that residents who are terminated are given multiple chances to remediate/change behavior/etc; in most of these situations, especially those described above, changing the hospital/program isn't a viable solution because the problem is a clinically incompetant or behaviorally unfit person. This is, after all, a job and people are fired from non-medical jobs with far greater frequency than residents are fired from programs. These residents aren't "scapegoats," they are the low percentage of people who simply aren't cut out for the position they are in. It isn't "easy" to lose a resident as it usually results in more work for everyone else if that position can't be filled and programs typically bend over backwards to try to make it work before the final step of firing someone. I'm not sure how you interpreted that as not taking responsibility or taking the "easy" way out.

There's no "underground" network. Sometimes people just aren't happy in the specialty they picked coming out of med school or they are unfit for it. These people can transfer to another specialty with the support of their program. If they are behaviorally unfit and aren't able to correct that behavior enough to minimally fit into the role they are being trained for, there isn't much you can do. It's not a shell game, it's trying to make the best of a bad situation.

Since I know you are interested in surgery once you complete medical school, here is the APDS website that lists open positions in surgery. Since it is posted in the open, it can hardly be considered something concealed. I don't know if anything like this exists for other specialties, because I'm not in those specialties. But as previously noted there are a plethora of other reasons why a program might have an open position. People going in or out of the lab, attrition in the first couple of years, addition of a new spot at a program (ie moving from a N categorical program to an N+1 program), etc.

 

[Light at end of tunnel]

Thank you eveyone for well thought out and constructive posts - will be doing some thinking/reflection for sure...

 

[Domperidone]

:/ i wonder if I came off a bit harsh at first.
particularly for any students reading. which reminds me, I really have to stop going on this forum after the end of a shift. Either I end up sounding incoherent or come off as a douche. i don't know when i started viewing this as a way to unwind after work, lol but it somehow happened.

most days, residency is like showing up to work with your friends.
that should be the environment you work in. your co-residents will be of a similar age, you share one very obvious common interest and spend way too much time together because of the rostered hours. When it's like that, it's very easy, very natural to assist each other when someone's struggling. not to mention, we're all terrified in this together, particularly at the start. there's whole intern threads about this.

but eventually, there's always going to be that rare situation where it just isn't going to work out. then it unfolds exactly how LucidSplash explained it.

I don't agree. It has been noted that residents who are terminated are given multiple chances to remediate/change behavior/etc; in most of these situations, especially those described above, changing the hospital/program isn't a viable solution because the problem is a clinically incompetant or behaviorally unfit person. This is, after all, a job and people are fired from non-medical jobs with far greater frequency than residents are fired from programs. These residents aren't "scapegoats," they are the low percentage of people who simply aren't cut out for the position they are in

with the clinically incompetent as co-resident..you can only do their residency for them for so long. it's not med school anymore. with the behavior issues, in the experiences I've had, usually it was some form of 'bullying'. if you're putting down other staff or demeaning them, how do you think it affects them? you also have to put into your mind that while it's a working environment, it's healthcare and "the patient is the one with the disease".

if i happen to sound bitter, it's because I still am from time to time.
early in intern year i was with someone who was not just struggling with day to day jobs, but lied about doing them. They were also incapable of seeing their own weaknesses and had no problem telling me i was terrible at my job. I had no comprehension at the time of what really constituted being a good or bad intern. So it was both a horrible and confusing time. Oh the joy. At least i was confused at first. I'd also have to watch a couple of friends/co-residents undergo similar situations, completely robbed of their confidence at the end of it. How much more of it would you allow to occur, how many times do you try to stop it, if it can even be stopped. It's different to a situation where someone actually had no idea what affect they had on others, until it was pointed out to them and they were able to adjust (this would apply to all of us)

I wouldn't dwell too deeply on this. @Light at end of tunnel.
it's another learning process. focus on what you're going through now. if you're in a good, supportive environment as a resident, there'll be others watching out for you. like the Fat Man in House of God.

 

[OMFRezDC]

No one cares about your grades in M1/M2.

You really need to relax.

Thanks for that.

 

[WingedOx]

Sigh. Rings so true with one of my junior residents I'm trying to work with right now.

They approach everything with a very hard-headed, right or wrong view. They also - if they perceive someone else to be less hard working or lazy or incompetent - act in a very outwardly demeaning way toward them...even their co-residents. Clinically the person is smart and does tend to be right in these situations more often than not. But their behavior in those situations is rough, and even after the fact they show little remorse because "they were right".

Chief resident year was a constant stream of dealing with this stuff.

Hard-headed opinionatedness seems to come with the territory with residents. Thankfully, throughout the course of training, most seem to get the proper experience to have hard-headed opinions that go from being wrong to correct once they figure out the way things actually work. I also thankfully only had one resident who caused mild to moderate problems dealing with other staff members, nurses, etc. ...and even better, the department clerical staff always found subtle and amusing ways to get back at this resident without any required intervention from me.

 

[Light at end of tunnel]

Chief resident year was a constant stream of dealing with this stuff.

Hard-headed opinionatedness seems to come with the territory with residents. Thankfully, throughout the course of training, most seem to get the proper experience to have hard-headed opinions that go from being wrong to correct once they figure out the way things actually work. I also thankfully only had one resident who caused mild to moderate problems dealing with other staff members, nurses, etc. ...and even better, the department clerical staff always found subtle and amusing ways to get back at this resident without any required intervention from me.

Again, what you are telling us is that the issues you personally encountered involved multiple other residents who as you say had to fall in rank one way or another and those that didnt were singled out for subtle and a bit concerning to me, "amusing" retribution by staff. If anything, what you describe comes off as sorority-type recruitee management, which is hardly amusing at any professional level.

Have you ever considered that just maybe *you* were part of the issues at your place? If I had to guess, probably not.

 

[Domperidone]

Have you ever considered that just maybe *you* were part of the issues at your place? If I had to guess, probably not.

That's pretty harsh to say to someone.
Or just making that assumption :S

just saying..

 

[LucidSplash]

Again, what you are telling us is that the issues you personally encountered involved multiple other residents who as you say had to fall in rank one way or another and those that didnt were singled out for subtle and a bit concerning to me, "amusing" retribution by staff. If anything, what you describe comes off as sorority-type recruitee management, which is hardly amusing at any professional level.

Have you ever considered that just maybe *you* were part of the issues at your place? If I had to guess, probably not.

No he's saying that the people that treated the nurses and clerical staff poorly were treated poorly by the clerical staff and the nurses until the behavior self-resolved. As a resident you really really need these people to be on your side. Getting too big for your britches and being demeaning is something that junior residents will try sometimes. Junior residents that have never had a "real job" and will think that because they have an MD after their name they are now at the top of an imaginary totem pole with the nurses and clerical staff at the bottom.

As a chief resident, correction of this behavior initially falls to you but much of the time the clerical staff and the nurses band together and the situation resolves itself.