Help me turn things around

[Jaydid]

I'm a categorical intern at a program that's known for being "tough," even for my notoriously also-"tough" (i.e. Ill-behaved!) specialty. I am concerned because I've gotten some fairly bad evals in the 3 months I've been here. I'm worried that I've pissed off the program director in the process as well.

Let me be clear. Most of my evals have been lukewarm/generic, which I'd expect given how little face time I've had with the majority of attendings I've worked with. The negative feedback I've gotten basically all boils down to time management, which is an area that I fully admit is very difficult for me. I do well in acute situations when I can hyperfocus on a very sick patient, and I have had a few good catches if I do say so myself (caught a PE, a post-op bleed and a couple of patients that were in early sepsis.) But these, of course, never seem to get mentioned (in fact, I'm not even sure if attendings are aware of them.) Thankfully, I'm naturally outgoing and even-tempered, and even the nastiest attendings put in comments about my good attitude, willingness to improve, and how I am easy to get along with.

The reason I'm worried I pissed off the PD is because he's on a service that I feel I performed the worst on. It was extremely high-volume, and I struggled to keep the details of all the patients straight in my brain when presenting, and struggled even more with completing tasks on time. Prior to this, I had already violated duty hours during the first two weeks of residency. I included an explanation that I thought was perfectly reasonable, but caught hell for it later, and was then educated by my co-residents that we basically have no choice but to lie about hours. I'm perfectly willing to do what I have to do, and am the first to admit that my efficiency is a work in progress. I struggle with getting notes done fast enough because for some reason it takes me forever to dig through old records. I also have a hard time if consultants don't call me back right away and my pager is blowing up in the meantime- I've had it happen when 2 or 3 pm rolls around and I realize I STILL haven't pinned down Dr. X from cardiology or whoever.

Fast forward to my rotation with the PD- I was really nervous about it, and on top of the aforementioned issues, I feel like everything-EVERYTHING possible- went wrong. I'm talking about stuff from broken printers to random transcription issues from dictations to pens exploding on my white coat- etc etc etc, you get the idea. I'd often respond by trying to give an explanation, "I'm not sure what happened, sir, as that patient was here last week when I was off..." or "I'm so sorry, I don't have a copy of the list, the printer was broken and I wanted to be sure I got here with plenty of time." to no avail. He reamed me out one day basically telling me that I sucked in every way and that I "made excuses" for things that went wrong. He literally told me that when someone tells me about a problem, he doesn't want to hear questions, what I think about it or anything else- all he wants to hear is "yes sir."

The last straw was today, when I got a bad review from an attending that I have NEVER WORKED WITH. I promptly emailed him, gently inquiring about some of the "instances" he'd mentioned and pointing out that we hadn't gotten a chance to review them because we "haven't crossed paths very often." (I.e. NEVER.) I have enough issues of my own, but when I start getting blamed for random crap that I have absolutely nothing to do with- well, that's a little hard to control for, isn't it?

I want any help I can get in being a better, more efficient resident, but after what my PD said that day, I worry that any attempt to go to him and discuss how to improve would be perceived as being "weak," "contrary" or just making extra work for him that he wants no part of. I should add that he's pretty openly mean to a lot of residents, so I'm not sure if I'm overblowing the fact that he ripped into me.

I'm in a really bad place and am interested in any advice regarding damage control and oh yea, actual improvement too.

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[ThoracicGuy]

I'm a categorical intern at a program that's known for being "tough," even for my notoriously also-"tough" (i.e. Ill-behaved!) specialty. I am concerned because I've gotten some fairly bad evals in the 3 months I've been here. I'm worried that I've pissed off the program director in the process as well.

Let me be clear. Most of my evals have been lukewarm/generic, which I'd expect given how little face time I've had with the majority of attendings I've worked with. The negative feedback I've gotten basically all boils down to time management, which is an area that I fully admit is very difficult for me. I do well in acute situations when I can hyperfocus on a very sick patient, and I have had a few good catches if I do say so myself (caught a PE, a post-op bleed and a couple of patients that were in early sepsis.) But these, of course, never seem to get mentioned (in fact, I'm not even sure if attendings are aware of them.) Thankfully, I'm naturally outgoing and even-tempered, and even the nastiest attendings put in comments about my good attitude, willingness to improve, and how I am easy to get along with.

The reason I'm worried I pissed off the PD is because he's on a service that I feel I performed the worst on. It was extremely high-volume, and I struggled to keep the details of all the patients straight in my brain when presenting, and struggled even more with completing tasks on time. Prior to this, I had already violated duty hours during the first two weeks of residency. I included an explanation that I thought was perfectly reasonable, but caught hell for it later, and was then educated by my co-residents that we basically have no choice but to lie about hours. I'm perfectly willing to do what I have to do, and am the first to admit that my efficiency is a work in progress. I struggle with getting notes done fast enough because for some reason it takes me forever to dig through old records. I also have a hard time if consultants don't call me back right away and my pager is blowing up in the meantime- I've had it happen when 2 or 3 pm rolls around and I realize I STILL haven't pinned down Dr. X from cardiology or whoever.

Fast forward to my rotation with the PD- I was really nervous about it, and on top of the aforementioned issues, I feel like everything-EVERYTHING possible- went wrong. I'm talking about stuff from broken printers to random transcription issues from dictations to pens exploding on my white coat- etc etc etc, you get the idea. I'd often respond by trying to give an explanation, "I'm not sure what happened, sir, as that patient was here last week when I was off..." or "I'm so sorry, I don't have a copy of the list, the printer was broken and I wanted to be sure I got here with plenty of time." to no avail. He reamed me out one day basically telling me that I sucked in every way and that I "made excuses" for things that went wrong. He literally told me that when someone tells me about a problem, he doesn't want to hear questions, what I think about it or anything else- all he wants to hear is "yes sir."

The last straw was today, when I got a bad review from an attending that I have NEVER WORKED WITH. I promptly emailed him, gently inquiring about some of the "instances" he'd mentioned and pointing out that we hadn't gotten a chance to review them because we "haven't crossed paths very often." (I.e. NEVER.) I have enough issues of my own, but when I start getting blamed for random crap that I have absolutely nothing to do with- well, that's a little hard to control for, isn't it?

I want any help I can get in being a better, more efficient resident, but after what my PD said that day, I worry that any attempt to go to him and discuss how to improve would be perceived as being "weak," "contrary" or just making extra work for him that he wants no part of. I should add that he's pretty openly mean to a lot of residents, so I'm not sure if I'm overblowing the fact that he ripped into me.

I'm in a really bad place and am interested in any advice regarding damage control and oh yea, actual improvement too.

Do you have a chief resident that you feel you can talk to? I would see if you can get with them privately, discuss your concerns, and ask for tips to improve. Don't make excuses. No one wants to hear about the printer or anything else. Once you've done that and started to take steps, ask your upper level residents on your service for feedback on your performance.

It sounds like you have the microscope turned on you. Your PD wants you to succeed. He wants you to get better. Maybe this is his way of doing that, I don't know. Try to know your patients cold. Make a list and check things off as you do it so you don't miss anything. Take care of consults at the beginning of the day. In time, you will improve.

 

[Jaydid]

Thanks. I just worry that this is "pre-terminal"- does it sound to you like they're trying to get rid of me? My PD has made several refernces about how "we don't do positive feedback in this field," and that he likes his residents scared. I hate to say it, but he seems especially nasty to the girls as well. I should also add that this is his first year as PD.

I have talked a bit with 2 seniors- it was somewhat helpful, but I don't really trust anyone at this point.

 

[AdmiralChz]

I just worry that this is "pre-terminal"- does it sound to you like they're trying to get rid of me?

Unless you are making really bad clinical decisions that's adversely affecting patient care (and this would ABSOLUTELY be brought to your attention quickly), then I doubt it. It sounds like you are in a categorical surgery (maybe subspecialty), but regardless there is little incentive to "get rid of people" at will. Think down the line of the massive headache it would be to cover your overnight or call shifts down the line - residents (especially after PGY-1) are not very easy to replace, particularly in categorical programs. If they "got rid of you" mid-year they would have to scramble to cover those services which would suddenly be down an intern.

Don't be so hard on yourself or so suspicious (read: paranoid) of others. If your program has a major problem they will address it with you, but if you really feel this way you need to discuss it with your senior residents or your attendings. Seek ways to get better, and like Thoracic Guy said do not make excuses.

I'm not going into too many specifics (could write a novel with intern musings), but the most basic thing about internship is making sure the plan you set forth in the morning gets done. The first things that need to be done (and fastest) are discharges (get them off your service!) and consults (it can take several hours for a consult note, depending on how busy the service is - you want an ANSWER for afternoon rounds and never say "oh, they didn't respond to my page" [hammer page them if it's important]). On afternoon rounds report back on what you did for that patient and how they are now closer to a discharge (or at least improved) scenario.

 

[Gastrapathy]

Never report another work hour violation.

Get there earlier.

Stay later.

Never say "not my patient" "I was off" etc.

Trust no one.

Oh, and, guess what, you'll be fine. At some point, that douchenozzle will even confide in you about how much he hates the current newbies.

 

[RelicLTD]

This ended up being quite lengthy. I apologize. I had a friend intern year who went through a similar thing, so it hit home with me. I'll do what AdmiralChz was smart enough to avoid and post my intern musings anyway.

TLDR: General solid advice above by all. Keys being: No excuses, come earlier, make sure you get the plan in action in the morning, and don't worry so much...

Note that you might be "under the microscope" now, and your response to this needs to be thoughtful but not over-reactive. The criticism can lead to growth. Best case, your PD is just rough around the edges in his teaching style. Worst case you are truly under the microscope. It may be hard to give specific advice cause I don't know your subspecialty. I did a year in internal medicine. I can't imagine how the surgeons do it because they were often done rounding by the time I was half-way through pre-rounds... so you may have to customize as required.

Being under the microscope:
One of my friends intern year, whom for reasons unclear to me, was noted to be "struggling" early in the year. A lot of it seemed to revolve around time management issues as well: consults, orders, notes. etc. I was surprised when I learned about it mid-year, because he was always a very strong resident, clinically at least, whenever I worked with him.

He confided in me that he was told his notes "needed to be perfect." This compounded the problem because now he spent even MORE time on his notes, and was finishing even later. Bear in mind working more will obviously give you less time to recover/enjoy yourself at home/exercise/whatever you do to relax... but the lack of time to recharge can compound the stress at work . Accommodations were made, such as fewer patients, bringing an extra intern to the team, having partial ward months, etc. I believe these kind of things bias attendings and senior residents as they assess your notes, presentations etc. Being under the microscope makes it harder. People say they are trying to help you, but having accommodations can actually make things more stressful in some ways.

Ironically while on the same service, I had copy/paste issues in my notes where a patient was going for "bronch in AM" three days in a row, and didn't catch it until a senior resident pointed it out. I also forgot to change an attendings name on my note when they switched off service. So while the other intern was expected to BE PERFECT, I had glaring flaws in my notes that were never mentioned in evaluations or by attendings.

Begin Advice:
=========================
In my opinion, what the attendings want... is to go home on time, collect their paycheck, and never be paged. They don't want to do an ounce of extra work that you could've done, or do detailed chart review/take the history themselves because you aren't "trustworthy". Ideally they want perfect patient care, with documentation that nets the max billable amount, and to feel like they taught you something... but thats all kinda secondary to them feeling like the day went smooth and that you aren't causing extra work for them or the team.

Gastrapathy, AdmiralChz, and ThoracicGuy have succinctly summed up EXACTLY what you need to do, but I will add a few extra details based on Gastrapathy's points.

Never report another work hour violation.
The ugly truth. Over time you will get more efficient. You will violate earlier in the year more than later. All it does is give your PD/chiefs a headache (remember they hate doing MORE work because of you). Reporting a violation will do nothing to help you. It's even worse if you get a "mandatory day off because you worked too much," and they have to pull another resident from elective to cover you. Your reputation will continue to precede you.

Get there earlier/Stay later.
This is about time management, so while you learn to be efficient, the alternative is to ADD more time, instead of cramming more tasks into less. I advise coming early, rather than staying late, but do both if you need to. Start with coming 45 minutes to 1 hour early in the morning BEFORE your pager starts blowing up (with meaningless potassiums and PVCs). Find somewhere quiet with a computer. We had a nice obs-unit that always had free computers and no through traffic that I would go to. As many of us are people pleasers, we want to return pages/assist with tasks right away, often breaking our train of thought. You'll be surprised how much smoother a day will go if you have a truly uninterrupted hour to do tasks YOU feel are important. You'll become more efficient and can titrate your extra time as needed.

My morning often went like this:
- Show up, grab a coffee.
- Sit at my station and print my handoff sheet and a coversheet with all team patients. Print an extra list if your attending is going to need one. (FYI now that you're early you have time to find another printer/restock the paper/troubleshoot that issue).
- Look over 24hr vitals/ins and outs/labs/nightly events. Make notes on my handoff sheet. Early in the year I wrote everything down IN THE ORDER I would later present it. Over time, I became better at presenting and could just make a few notes per patient. Later in the year I would generate my note template as I reviewed the chart, so it populated into my EMR inbox to make sure I did them all.
- Look over the list and prioritize the order I in which I would pre-round. There are times I knew I couldn't spend too much time with some patients to make it to rounds on time. If early enough I just go for the fewest elevator rides/stairs/building changes.
- Generally at this point it was time for handoff so I would go to handoff and hear about any signficant events.
- Preround, talk to nurses for sick patients/all if you can/ check telemetry.
- Grab a second coffee and go back to the computer to follow any morning labs that weren't back when I first came in. I would add presentation notes to my sheet, and later in the year, start filling in my progress note in the EMR. I found that working on wording my progress note helped me with my A/P thought process as well as my presentation.
- Talk with the senior resident about any questions for patients/"run the list"
- Time for rounds.

That extra hour in the MORNING makes a bigger difference than the extra hour after work when you are beat. Plus what the attending SEES is how well you you know your patients at rounds and how well you present. Will they see you fumbling papers looking for a hastily scribbled lab value? Or see you only glance at your paper once or twice during an organized presentation? That extra time in the morning can make you look like a rock star. They don't see how much time you spend on your notes later in the day. And if they do it's because you are "taking too long." They want to cosign your note before they go home.

Never say "not my patient" "I was off" etc. - ie No excuses.
I understand your urge to defend yourself. I get it. If the person signing out to you from the weekend didn't tell you what happened/you weren't here/whatever.... it's frustrating. The printer thing is annoying. A nurse who lies to you is annoying. A patient event that literally no one told you about/isnt documented that bites you in the ass is annoying. Some of these are unavoidable. The printer thing is avoidable. Avoidable issues are solved by being earlier. As you trouble shoot the issues early in the year, you'll carry that experience forward and need less time in the morning. The hard truth is no one cares why... and it's not changing anything now. At this point you just have to TAKE IT UP THE ASS. There is no way around it. Your line is, "I apologize sir/ma'am. It won't happen again." And say it with sincerity. NEVER lie, either. If you don't know or you mess up, say so immediately, followed by the above line.

Trust no one.
Generally agree. And it applies in more than one way:
1) Seeking help for struggling. The less people in your residency involved in this the better. It can start to spiral and compound on itself as happened to my co-resident above.
2) YOU are responsible for your patient. If someone says they are going to do some task for you, sign out that patient for you, call that consultant for you/ w/e, YOU have to follow through. Dont assume it will get done.

Oh, and, guess what, you'll be fine.
Its true. You're likely just going through intern growing pains, and had a bad run... But just heed the above to avoid the microscope effect.

Honestly the first 4-5 months I would say focus on your efficiency, rather than on reading for your specialty. Look up as you need to for active patient care, but the rest is about learning to get through the day in an organized and efficient manner. As you get faster, you'll start getting home on time, your performance will improve, and you'll have time to read a little deeper.

My advice for improving efficiency in a way that will translate to better performance:
Step 1- be early enough to gather all the info. Vitals, labs, exam, double check orders/meds/imaging. Preparing for procedures/etc.
Step 2- have an organized way to note this info to yourself. Early in the year I tried to print a pended note because it auto pulled labs/vitals for everyone. Too many papers and sometimes computer issues. I settled on the signoff sheet that had a brief patient summary, room, last labs. I wrote S, O, A, P on each one and presented off it.
Step 3- learn to present well. hearing new interns present now... it's total chaos. Trying to listen for information that doesn't come where you expect it to is very painful. Practice in the established format. Initially you may need to say a lot that you can trim out, just to prove you looked it up/did the exam (eventually, "exam was unchanged" and only saying truly relevant labs) that saves time. Attendings vary in what they like, and you'll just adapt to that.
Step 4- make a small checklist regarding what the team plan is DURING rounds. If you are confused, run that past your attending/fellow/senior immediately while its fresh.
Step 5- After rounds IMMEDIATELY put in orders and IMMEDIATELY call consults. Your checklist will help make sure no orders fall through the cracks. Ideally your team puts in the orders ON rounds. We had some attendings who had weird styles where this wasn't feasible. Until you rotate on consult services, you have no idea how obnoxious it is to get new consults at 3pm. DO NOT work on your notes right now. DO NOT go get a snack, or look up some fact you think the attending was wrong about on rounds. Put the team plan IN ACTION. Fine tuning your note affects you. Everything else affects the patient, the team, the consultants, etc.

I repeat here for emphasis- the priority after rounds is: orders = discharges > consults > follow up gaps found during rounds > run through your checklist >update your signout/handoff > and lastly notes. Do your orders and consults before you take any significant time break.

All of the above should help the service run smoother. But you also want to be efficient so you can go home on time and occasionally enjoy something outside of medicine, which does wonders for you in both parts of your life. So the last bit here is just advice for you to go home on time:
- Don't waste time in the afternoon. It's tempting to relax right after rounds or after lunch as the orders in, consults called, nurses are calm... but this is prime time to churn out work (discharge summaries, pended notes, etc).
- If your attending does afternoon rounds, make damn sure you followed up on everything, even the little stuff (call PCP, call pharmacy). This is why you made that checklist for EVERY patient during rounds. If it was discussed at rounds as part of the plan... follow up. If you consulted someone, what did the consultant say? If you ordered a lab, follow up the result. If you were gonna call radiology to clarify an imaging report, make sure you do it before the afternoon rounds.
- Update your signout/handoff sheet early in the day (because it affects the team). You never know when you'll have the golden opportunity to sign out early.
- Refine your note style, eliminate unnecessary stuff, and tweak your templates, and they will go MUCH quicker. Use phrases like "AKI, improving" instead of having to update the Cr from 1.0 to 0.9... That way, tomorrow, if it's still improving- you saved yourself 30 seconds of double checking the number, and a few clicks/keystrokes to replace. The stupid "# of clicks" actually starts to get to you. The time savings really add up.
- Go meet all your support staff, RNs, RTs, and especially SOCIAL work. Go chat with them. Know their names BEFORE you need a favor from them. Putting in face time with the social worker and just knowing they had a daughter in pre-school made some of my discharges run a lot smoother.
- If you had several discharges/light load, help out the team however you can (get the ultrasound and the kit for the procedure, call the micro lab, whatever). Don't just sit around refreshing the labs.


Hope you found this helpful. Sorry for the length. You will survive !

 

[Jaydid]

This is pure gold- thanks to all! So, it seems like the consensus is NOT for me to drag myself to the PD unprompted, telling him how much better I want to do and so on...? Normally, in any other professional scenario, this would be my first response- draft a self-improvement plan, go to my superior, tell them "I know I need to get better and here's what I plan to do about it." But this guy takes pleasure in kicking people while they're down. I was listening to what he said to chiefs presenting at our weekly conference the other day, and... well, there's no other word for it: it was abusive.

 

[RelicLTD]

This is pure gold- thanks to all! So, it seems like the consensus is NOT for me to drag myself to the PD unprompted, telling him how much better I want to do and so on...? Normally, in any other professional scenario, this would be my first response- draft a self-improvement plan, go to my superior, tell them "I know I need to get better and here's what I plan to do about it." But this guy takes pleasure in kicking people while they're down. I was listening to what he said to chiefs presenting at our weekly conference the other day, and... well, there's no other word for it: it was abusive.

I would come up with said self-improvement plan, try it for a few days. If you feel the need to discuss with someone, talk to an upper level you trust. If you get called to meet with a chief or the PD you already have a plan, and you can be ready for a discussion that displays humility and self-awareness. At this point I'd chalk it up to PD has a penchant for "strong criticism" and take comfort in the fact that it seems to be going in multiple directions, not just at you. Just use your previous string of evaluations as motivation to try to improve yourself.If you improve without them feeling like they had to meet with you, all the better.

I promise you'll get better. I got reamed a couple times early on for not being thorough enough/following through on details. I had a couple presentations in the ICU that were interrupted and I was told to start over because they were so bad. I'll be the first to admit I was a weak presenter and often let details fall through the cracks in the name of the big picture... But by then end of the year I had lots of glowing evals, and my PD told me they would make a spot in the program if I wanted to stay in IM.

My gut says to leave the PD out of it. If they feel that they need to talk to you, they will. Just one man's opinion though.

 

[AdmiralChz]

- Go meet all your support staff, RNs, RTs, and especially SOCIAL work. Go chat with them. Know their names BEFORE you need a favor from them. Putting in face time with social work and just knowing they had a daughter in pre-school made some of my discharges run a lot smoother.

I can't emphasize this one enough. A good and friendly social worker is an intern's best friend because they facilitate the basic goal of internship - effective and efficient discharges. By talking with them and alerting them ahead of time of difficult discharges (usually nursing home or rehab transfers, sometimes hospital-to-hospitals) they can let you know ahead of time what is needed (typically, a complete discharge summary and a medication reconciliation - literally the patients at our hospital could not leave without these). This all seems like ancient history to me, thankfully, but I remember how helpful SW was in this scenario.

RelicLTD wrote an awesome couple posts above which is readily applicable to surgical services as well. I agree with the sentiment to leave the PD out of it, it seems like that conversation may not be very productive given his/her disposition you've described.

 

[wholeheartedly]

RelicLTD just earned a $10 amazon gift card as a thanks for the great contribution!

Keep up the great responses everyone.

 

[Apollyon]

-Show up, grab a coffee.
- Grab a second coffee

Not to be gross or anything, but, when did you budget time to get to the can?

 

[evilbooyaa]

Not to be gross or anything, but, when did you budget time to get to the can?

No pooping allowed until after the work is done.

 

[bannie22]

I agree with some of the above points.

Trust nobody.
Talk to nobody.
Response is limited to Yes/No.

Is it really a good idea to lie about duty hours? I feel like it would be an integrity and professionalism issue.

Is it fair that people don't provide good signout and you don't know the patient? No

Is it fair that people blame you for stuff you had no idea existed in the universe? No

However, this is residency. And the long term goal is to survive residency, so it is unfortunate that for the time period respecting the three rules would keep you safest.

 

[Jaydid]

Well, it finally happened. Two of the chiefs (one of whom who has hated me from day 1 for some reason) sat me down and basically told me what a terrible job I'm doing. It wasn't a surprise- I am trying SO HARD, but as I told them, I'm not at the level I want to be either. I would say that I'm "book smart," but I have a terrible time learning by watching, and I'm a fairly slow learner when it comes to the process of things (this is what we do at hospital A vs B, this is how the EMR works, etc.) This is all really hard to fix by studying. I have actually taken steps to get tested for a learning disability recently, because despite an excellent academic record, boards, etc. , I am just too slow to learn things in a work environment- this has caused trouble for me for my entire life. If i'm going to learn a procedure, I need to go through it in a safe environment first, where I can be walked through it, ask questions and then repeat it multiple times in independent practice. Unfortunately, this doesn't seem to fly in my program/specialty, where you are expected to watch a youtube video and be able to do it.

Also, I do REALLLLY badly when I'm feeling terrorized, which is 99 percent of the time, as I certainly seem to have been pegged as the slow gazelle. When I applied, I asked myself a lot of heavy questions about whether I could learn while having to deal with all the malignant personalities I knew I'd run into. I finally surmised that no one likes dinguses, therefore my dislike of dinguses should not keep me away from something I love. I know part of my situation has to do with my own anxiety/ fear of authority figures.

So, to be clear: no formal probation, no sit down with faculty, just the the meeting with the 2 chiefs as described- they actually said I might want to think about looking into other specialties while there's time for next year. I asked them if they thought I could turn things around, and they said probably yes, but to keep in mind how much it sucks to be under the microscope (as if I didn't know.) They then suggested setting up a meeting with our APD (who, unlike the PD, seems like she'd sincerely want to help.)

Does this sound at all salvageable, or is the writing already on the wall?

Also, regarding non-renewal: can they just do it without an attempt at formal remediation/probation/etc? I know they can't just fire you mid-year unless you do something totally nuts, but not sure if non-renewal is the same animal.


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[ScubaV]

It does sound like your personality and learning style do not mesh well with your specialty (guessing some type of surgical field?). I would follow other people's advice for how to attempt to turn this around, but if you don't get a contract renewal (seems most likely) it would help you to have some backup plans in place. At least thinking about what other fields to apply to would be beneficial.

 

[AdmiralChz]

Well, I can certainly see your concern. But there is no use in cowering in fear, and your admission that you do so poorly under pressure speaks to a lack of confidence. Residency is all about gaining skills and confidence for a career afterwards, but you have to be willing to fight for it. To be blunt - right now it seems like you are so upset that you are ready to fall on the ground and cry. Weakness is HATED in surgical fields and stamped out quickly - how can you expect to take care of that emergent, dying patient coming into the operating room? Think you will have an hour to rehearse your surgical decisions?

That being said, you can absolutely overcome this through some serious grit and resolve if you want to. No one expects you to be a master at procedures the first time you see them, but you have to show initiative and willingness to learn. Sometimes you might not be able to do as you say and practice at home - surgical procedures don't lend themselves to such things. Before each procedure, briefly rehearse all the steps you'll need to do in the proper order - write them down and go through them at home if you need to. Seeking out the advice and help from your APD sounds like a great idea if she has offered, but I agree if you have a poor relationship with your PD it might be best to avoid a discussion with him/her (but the APD will definitely have more applicable advice, and can keep the PD advised on the down-low).

Like I said, this will take a LOT of work on your part and you will have to move past the self-loathing and fear of being terrorized. There is a lot of adversity in residency and afterwards, you must be willing to face it head on. If no then consider a switch into a different field - General Surgery has a fairly high transfer rate for these very reasons. If you are at a program with a categorical GS or subspecialty, chances are there are other fields (IM, FM, Peds, ED, Psych) at your institution and you should consider setting up a meeting with the respective PD of that specialty to discuss a switch. It is very late in the process but not impossible to switch into something, especially if you have a competitive application (and if you are in categorical surgery or especially subspecialty, then you likely have a solid application). You very well might have to repeat intern year, but it would be a small price to pay. Think it over carefully.

 

[ThoracicGuy]

Well, it finally happened. Two of the chiefs (one of whom who has hated me from day 1 for some reason) sat me down and basically told me what a terrible job I'm doing. It wasn't a surprise- I am trying SO HARD, but as I told them, I'm not at the level I want to be either. I would say that I'm "book smart," but I have a terrible time learning by watching, and I'm a fairly slow learner when it comes to the process of things (this is what we do at hospital A vs B, this is how the EMR works, etc.) This is all really hard to fix by studying. I have actually taken steps to get tested for a learning disability recently, because despite an excellent academic record, boards, etc. , I am just too slow to learn things in a work environment- this has caused trouble for me for my entire life. If i'm going to learn a procedure, I need to go through it in a safe environment first, where I can be walked through it, ask questions and then repeat it multiple times in independent practice. Unfortunately, this doesn't seem to fly in my program/specialty, where you are expected to watch a youtube video and be able to do it.

Also, I do REALLLLY badly when I'm feeling terrorized, which is 99 percent of the time, as I certainly seem to have been pegged as the slow gazelle. When I applied, I asked myself a lot of heavy questions about whether I could learn while having to deal with all the malignant personalities I knew I'd run into. I finally surmised that no one likes dinguses, therefore my dislike of dinguses should not keep me away from something I love. I know part of my situation has to do with my own anxiety/ fear of authority figures.

So, to be clear: no formal probation, no sit down with faculty, just the the meeting with the 2 chiefs as described- they actually said I might want to think about looking into other specialties while there's time for next year. I asked them if they thought I could turn things around, and they said probably yes, but to keep in mind how much it sucks to be under the microscope (as if I didn't know.) They then suggested setting up a meeting with our APD (who, unlike the PD, seems like she'd sincerely want to help.)

Does this sound at all salvageable, or is the writing already on the wall?

Also, regarding non-renewal: can they just do it without an attempt at formal remediation/probation/etc? I know they can't just fire you mid-year unless you do something totally nuts, but not sure if non-renewal is the same animal.


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It sounds like the chiefs were trying to help you out with this. I'm sure that this was done with the full knowledge of the APD or PD or both. They did seem to provide some hope that they thought you could improve and get through this, so there's that. It depends on how bad you want it.

As for surgical procedures, there's not many procedures that you can do in a "safe environment" and then practice independently prior to the real thing. There's only so much a simulator can do and that only can manage certain procedures. You can't really practice open procedures this way unless its with animal models which wouldn't be available on a usual basis. I'd suggest watching a few videos - youtube certainly has alot of great examples - and then as @AdmiralChz suggested, write down the steps on a piece of paper so that you have in your head what you'll plan on doing in the surgery. Then when you get in the surgery itself you can participate more rather than just watching. This will lead your faculty to see you more engaged in the procedure. They will be more willing to show you and teach you if you have shown initiative.

Most of the faculty out there are not out to get residents. They want you to learn and be good. Some of the teaching styles can be difficult, though. Even with those that are hard on you, it is usually not a personal thing. If you know several days in advance that you have a big surgery coming up, study on it and try to meet a few minutes with the attending for that case the day before to review the surgery that you'll be assisting on. They will like that, I'm sure.

If your APD seems approachable, by all means meet with her. If getting through your training is what you want to do, then coming up with strategies to improve will show your initiative in improving. You don't have to be perfect, but show interest, improvement, and initiative and you will get supporters. You said you are working hard, but maybe the way you are doing it is not the right way and you can do something better. Do you have any co-residents that you feel you are close enough with to get some help with being more efficient?

As for non-renewal, that can be done without remediation or probation periods. There is no rule that you have to be reappointed each year for a position. They do need to make sure you have plenty of notice though and can't just say they aren't going to renew you in May or anything.

Getting a spot in another specialty may be difficult at this time given how far we are into the interview season. If you did look to switch, something at the same institution would likely be your best bet. But first you really want to make sure that is what you want to do. If your APD or PD knows you are interested in switching, that might make it easier for them to not offer you the renewal letter.

So in summary, you need to make sure you do everything you can to prepare for surgeries that are coming up with reading and videos. Stay proactive and discuss cases with your attendings. Try and talk with supportive co-residents to help you do this. Try to lose the feeling of fear as much as possible. Determine for yourself what you want as your goals. Meet with the APD and discuss ways to improve.

Good luck.

 

[Jaydid]

Thanks for the replies. And apparently, this whole intervention was in fact done without any prompting from the higher ups. I am weirdly relieved, feel completely committed to improving- hell, I've even thought that I'd love to repeat intern year if I could, just so I could learn while already being used to the EMR, city, hospital layout, etc.

I haven't talked to any faculty yet, and before I do, I'd love some advice on how to figure out if I should start looking for another spot or not. I don't actually want to, and would much rather repeat the year if I had to choose between the two. Luckily, there are multiple other things that I could see myself doing (and maybe even doing better in- as another poster said, my personality is distinctly out of sync with most in my specialty.) Given that, would it be a good idea to put my feelers out to the PD's of multiple specialties within my institution? I feel that this would be very tricky because a) no one likes to think they're a fallback, or a fallback to a fallback and b) this might be viewed as very shady from the prospective of my current faculty as well as those of the other programs. C) I don't want to bring up the possibility with my program, lest it serve as an opportunity. I would especially love to hear from anyone who had repeated a year (or knows someone who did) and ended up okay. What determines whether the program will do this? How does it work with funding?

I already have a study plan in place. I can practice technical skills (which the residents/faculty I'm not terrified of tell me are just fine for my level.) Admittedly, during the first 4 months, I felt that I had NO time to study, not without serious sleep deprivation anyway, and now that's changing. The thing I worry I have less control over is speed. For example: when a consultant repeatedly doesn't call you back, what to do? You can't really sit tethered to one phone for very long when your pager is blowing up, etc. Also, I find it difficult to take control of my time sometimes- I'll get in my groove and some bitchy senior will tromp in and start making demands, or I'll ask someone for a piece of equipment that will take 20 minutes, etc. I realize these happen to everyone, but how to prevent it from throwing me off?

I think one part of my problem was inefficiency---> sleep deprivation---> reduced confidence, reduced study time---> more inefficiency.


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[gutonc]

hell, I've even thought that I'd love to repeat intern year if I could, just so I could learn while already being used to the EMR, city, hospital layout, etc.

I've never really understood this excuse/explanation.

Every hospital is the same...follow the signs to the unit you're looking for. Every EMR is the same...they all pretty much suck...figure out how to muddle through and get the real work done, that should take a day or 3. The city is irrelevant, figure out how to get to and from the hospital each day. Sleep on your day off.

 

[Jaydid]

I'm sure a lot of people are like you, Gutonc. These are the people who don't have alarm bells in their heads when they hear "5 hospitals, rotating monthly." Unfortunately, we aren't all so adaptable.


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[AdmiralChz]

For example: when a consultant repeatedly doesn't call you back, what to do? You can't really sit tethered to one phone for very long when your pager is blowing up, etc.

You need to be multitasking - work on discharges/notes while you wait for a return call, don't just sit there staring at the phone. All of our phones were right next to a computer terminal to help with this - most EMRs let you pull up two windows so you can keep the patient you are consulting up so you can quickly read off the MRN and another one to do busy work on. Yes you are super busy, but trust me from the consultant side they are busy as well. Do other administrative tasks as well - orders, medication reconciliation, etc...

Repeating intern year is a poor option unless you have had some sort of serious medical or family problem preventing you from completing the year (and from what it sounds like, you don't). As we've said above - they need more senior residents to do more senior work and there is pressure from GME offices to continue taking new graduates in training. They simply can't waste years on a single resident, it creates too many hurdles down the road.

 

[NotAProgDirector]

I would only start contacting other PD's if you've made the decision to transition out of the field you're in. If you're going to stick it out, then focus on your current program.

 

[gutonc]

I'm sure a lot of people are like you, Gutonc. These are the people who don't have alarm bells in their heads when they hear "5 hospitals, rotating monthly." Unfortunately, we aren't all so adaptable.

Lack of adaptability should be a hard stop (10 points to Hufflepuff if you recognize the EMR that references) contraindication to a career in medicine. The ability to rapidly adapt to new data (patient data, clinical data, research data etc) is critical to the practice of modern medicine.

The bummer of it is, that doesn't really get adequately tested until, as in your case, it's much too late.

 

[ThoracicGuy]

I'm sure a lot of people are like you, Gutonc. These are the people who don't have alarm bells in their heads when they hear "5 hospitals, rotating monthly." Unfortunately, we aren't all so adaptable.


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I had five hospitals to rotate through during residency. Yeah, the computer systems were different and the layouts were totally changed as well. That should only really make a difference the first week or two the first time you are at that hospital. The next time you are there, you should be up to speed after a day at most.

Don't psych yourself out about these things. Reading, hard work, initiative, and affability are what you need to focus on.

 

[shopsteward]

Switching to another specialty is hard. One of the big problems for you would be that I'm not getting any indication from you that you would be committed to a different specialty and that you could persuade a program director in that specialty to take you. Unless you can find something else that you think would suit you better, with reasons, and can be convincing about how it will be right for you, finding somewhere to switch to could be difficult. Also, you may just be taking your existing problems into a new setting. Even if that setting is less pressurised, the problems will still be there and making life more difficult.

You do still have the chance to turn things around where you are, but will need a new mindset if you are to do it. I suggest -

1. You say you are book smart but have difficulty learning by watching. That's just a matter of learning styles: convert your watching experience into a book experience and it is solved. That could mean writing lists for yourself - if you are watching a procedure take notes, if you are watching a youtube video take notes, if someone is explaining how the EMR works take notes. You might find that just writing it down is enough, or you might need to review and refer to your notes a few times. But you just need convert new information received in a learning style that is difficult for you into one which isn't.

2. On time management, take your cues from what your peers do and copy how they handle things. Watch how they manage, ask how they do things. Sometimes small details can make a big difference, and your fellow residents should have good tips. You may find that this involves just a tiny bit of thinking ahead - eg if you know you will need someone to call you back, do it from a phone which is in the right place for you to be getting on with your next task while you wait.

3. I'm getting an air of generalised panic from your posts, which if it is carried over to your working day will make things much more difficult for you. There might be something in this post on stoicism which will help you to push those feelings back and concentrate on what is most useful - http://dailystoic.com/happy-stoic/

Best of luck.

 

[skypilot]

Lack of adaptability should be a hard stop (10 points to Hufflepuff if you recognize the EMR that references) contraindication to a career in medicine. The ability to rapidly adapt to new data (patient data, clinical data, research data etc) is critical to the practice of modern medicine.
.

Sheesh, the guy is in a malignant program in an extremely competitive specialty. Just because he is struggling doesn't mean he isn't cut out for medicine. Certainly we can't make that judgement on an internet forum. There are less malignant programs out there, and there are less competitive specialties, and if it truly is not working out for you then you may have to switch. That having being said, attendings have always loved to torture residents and residency is about survival. So you are not alone.

 

[Jaydid]

Thanks all. One thing I do have is perspective. It occurs to me on a daily basis that the way my attendings and chiefs act would get a toddler a time-out in any respectable pre-school.


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[Jaydid]

Just when I've been feeling like I finally hit my stride, I got the news today that they unfortunately might make me repeat the year. My APD called me into her office and dropped the bomb. She was really nice about it though, and said that "my issues are far from insurmountable," and that she thinks I might have just been shell shocked by residency. (I would tend to agree.) Nonetheless, she said that based on numeric milestones, (I.e. Review scores) there is a good chance I'll be asked to repeat. She made it clear that they have to say who's repeating by Feb., and can always decide to advance a person later. I should add that my program has a history of making people repeat years, and apparently some have gone in to do well. I would actually be fine with repeating, but I do worry about the stigma/microscope effect being even worse and ultimately ending badly anyway. I was relieved that she made a point to say that they weren't going to fire me, although I am a little puzzled that probation didn't come up. (Doesn't that usually come before talk of repeating?) Anyway, I'm not sure what's worse.

The meeting ended with her giving me a hug and telling me to "show 'em." Nice to know that they don't flat out hate me, I guess?




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[rokshana]

Just when I've been feeling like I finally hit my stride, I got the news today that they unfortunately might make me repeat the year. My APD called me into her office and dropped the bomb. She was really nice about it though, and said that "my issues are far from insurmountable," and that she thinks I might have just been shell shocked by residency. (I would tend to agree.) Nonetheless, she said that based on numeric milestones, (I.e. Review scores) there is a good chance I'll be asked to repeat. She made it clear that they have to say who's repeating by Feb., and can always decide to advance a person later. I should add that my program has a history of making people repeat years, and apparently some have gone in to do well. I would actually be fine with repeating, but I do worry about the stigma/microscope effect being even worse and ultimately ending badly anyway. I was relieved that she made a point to say that they weren't going to fire me, although I am a little puzzled that probation didn't come up. (Doesn't that usually come before talk of repeating?) Anyway, I'm not sure what's worse.

The meeting ended with her giving me a hug and telling me to "show 'em." Nice to know that they don't flat out hate me, I guess?




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what's worse? you are getting the best possible option...they are at least planning on keeping you...

 

[Bonferroni Correction]

The "stigma" will be in your head more than anyone else's. The fact that you seem intent on accepting criticism and moving forward is 99% of the battle. If you keep improving, nobody will care about an extra year that you used to improve yourself.

P.s. I'm a long-time reader, first-time poster. Figured I'd make an sdn name tonight rather than finish my PowerPoint.

 

[AdmiralChz]

A strong performance on your upcoming in service exam with go a very long way in your favor, especially with your program directors. I would be spending as much time as possible studying for it - be one of the stars of your class.

 

[mcl]

Just when I've been feeling like I finally hit my stride, I got the news today that they unfortunately might make me repeat the year. My APD called me into her office and dropped the bomb. She was really nice about it though, and said that "my issues are far from insurmountable," and that she thinks I might have just been shell shocked by residency. (I would tend to agree.) Nonetheless, she said that based on numeric milestones, (I.e. Review scores) there is a good chance I'll be asked to repeat. She made it clear that they have to say who's repeating by Feb., and can always decide to advance a person later. I should add that my program has a history of making people repeat years, and apparently some have gone in to do well. I would actually be fine with repeating, but I do worry about the stigma/microscope effect being even worse and ultimately ending badly anyway. I was relieved that she made a point to say that they weren't going to fire me, although I am a little puzzled that probation didn't come up. (Doesn't that usually come before talk of repeating?) Anyway, I'm not sure what's worse.

The meeting ended with her giving me a hug and telling me to "show 'em." Nice to know that they don't flat out hate me, I guess?

I think this is a program that's looking out for you. Probation is a stigma that you'd have to report every time you apply for a license or hospital privileges forever. Yes, you'll have to explain the extension of residency, but that doesn't raise the red flags that probation does. Just a sentence about not meeting expected milestones early in training and working hard to overcome the setback in order to become a better, more competent physician at graduation.

 

[Jaydid]

Yikes, I honestly hadn't even thought that far ahead to having to report an extension in training. I'm focusing on just keeping my head above water today. I assume that can really kill you for fellowship?


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[ThoracicGuy]

Yikes, I honestly hadn't even thought that far ahead to having to report an extension in training. I'm focusing on just keeping my head above water today. I assume that can really kill you for fellowship?


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If you're going for peds, surg onc, or another highly competitive fellowship, probably. For others, might not. The biggest thing is how you bounce back from this.

 

[Jaydid]

How about trauma or transplant?


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[ThoracicGuy]

How about trauma or transplant?


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Those are usually not very competitive. Right now just work on getting better. Go all in on the absite. I think you can do it. A good number of people in your situation are oblivious. They will have a harder time turning it around.

 

[Jaydid]

I'm feelng more and more like I can do it, too- as I said, I have alteady experimented with a few things that seem to make life easier, and I had all of our notoriously worst rotations first. Nowhere to go from rock bottom but up, right? I do have a concern about a particular chief who will be staying for fellowship. She has gone out of her way to make my life miserable even before she'd ever worked with me- I'm talking like, 2 weeks in, when I'd exchanged maybe 10 words with the girl. As you might guess, she was one of the two who had the "sit down" with me (along with her friend, who is slightly less terrifying.) She'll start screaming at me for not knowing things that I'll later find out not even my seniors know. I know I'm responsible for learning the appropriate material, but I worry that her hatred for me isn't going to play well in the situation. Fortunately, she herself is hated by many attendings. (The environment at my program, in case you haven't caught on by this point, is absolutely out of control. Oh, that 20/20 hindsight.)

I do want to optimize my risk/benefit ratio. So let's say I move on, or even get held back, but the target on my back is insurmountable and I later get the boot. Am I imagining that it would be harder to find another slot in something else if this happened after say, 3rd year? Would I have a shot at starting over in something else at that point?

 

[ThoracicGuy]

I'm feelng more and more like I can do it, too- as I said, I have alteady experimented with a few things that seem to make life easier, and I had all of our notoriously worst rotations first. Nowhere to go from rock bottom but up, right? I do have a concern about a particular chief who will be staying for fellowship. She has gone out of her way to make my life miserable even before she'd ever worked with me- I'm talking like, 2 weeks in, when I'd exchanged maybe 10 words with the girl. As you might guess, she was one of the two who had the "sit down" with me (along with her friend, who is slightly less terrifying.) She'll start screaming at me for not knowing things that I'll later find out not even my seniors know. I know I'm responsible for learning the appropriate material, but I worry that her hatred for me isn't going to play well in the situation. Fortunately, she herself is hated by many attendings. (The environment at my program, in case you haven't caught on by this point, is absolutely out of control. Oh, that 20/20 hindsight.)

I do want to optimize my risk/benefit ratio. So let's say I move on, or even get held back, but the target on my back is insurmountable and I later get the boot. Am I imagining that it would be harder to find another slot in something else if this happened after say, 3rd year? Would I have a shot at starting over in something else at that point?

It would depend on what caused you to get the boy, but it could still be possible to continue in surgery. I wouldn't worry about that one chief. As a fellow, they will have less impact on you. Just do everything you can to start under the radar. Work hard, be a team player, and try to minimize complaining and you can start to rehab your image. It can be done.

 

[shopsteward]

I'm talking like, 2 weeks in, when I'd exchanged maybe 10 words with the girl.

If you are thinking of a grown woman who has an undergraduate degree, has successfully completed 4 years of medschool to get an MD/DO and has successfully completed several years of residency as a "girl" then that is an indication of one of your problems right there.

I suggest you seriously recast any mode of thinking or talking that is less than respectful to your elders and betters (as things stand this woman is both), and stop even thinking in a way which disrespects anyone on grounds of race, sex, gender, disability or any other physical characteristic.

 

[Jaydid]

Whoa, hold your horses there...purely a figure of speech, and I made no indication of discriminating against anyone, nor is such a comment relevant to this situation.


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[shopsteward]

Whoa, hold your horses there...purely a figure of speech, and I made no indication of discriminating against anyone, nor is such a comment relevant to this situation.


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It is indicative of a dismissive and discriminatory mindset. Careless talk costs (incipient) careers.

 

[shopsteward]

You're overreacting

Am I? I'm just trying to get it into OP's head that he is (quite probably unintentionally) projecting a disrespectful attitude about his chief resident, with whom he has documented he has "a difficult relationship" and who has apparently hated him from day 1 "for no reason". And yet this person did go to the trouble of providing him with a friendly, unofficial, warning about his performance before formal steps started against him.

When OP has already admitted to a number of bad evaluations, having pissed off his PD, and being told he needs to repeat a year, he needs his chief on his side (as others have advised). Being careful about his attitude towards said chief seems a no-brainer, but it is not indicated in OP's posts so far. It's a common complaint around here that residents in trouble lack insight into the causes of their trouble.

 

[rokshana]

It is indicative of a dismissive and discriminatory mindset. Careless talk costs (incipient) careers.

or being born and raised in the south...just sayin'...

 

[Jaydid]

Interesting development: a few days ago at conference, one of my favorite attendings appeared in front of me, stood there awkwardly fidgeting around for a minute and then blurted out, "would you like a mentor?" I was a little taken aback but said "of course!" He then went on to say how much he had enjoyed working with me and that he thought I had a lot of potential, but just needed some help with the details. He sighted the example of my having technical difficulties a few times on his service- for example, one day all my progress notes were listed in the system as consult notes. (I am completely inept with computers admittedly, and still don't completely understand how I managed to accomplish this uniquely stupid feat.) Then, I started worrying about how everyone must be talking about all my dirty laundry, etc etc. I tried to console myself with the fact that in this program, everyone talks **** about everyone, so this would hardly be a standout, even if true. Then, just today, I received my most positive round of evals all year from the attendings on that same service, which was also my most recent. I also got my evals from the previous month, which were a heck of a lot better than from October and before.

This is a filthier business than I ever thought... but wow, that little boost came just at the right time.

 

[Bonferroni Correction]

Interesting development: a few days ago at conference, one of my favorite attendings appeared in front of me, stood there awkwardly fidgeting around for a minute and then blurted out, "would you like a mentor?" I was a little taken aback but said "of course!" He then went on to say how much he had enjoyed working with me and that he thought I had a lot of potential, but just needed some help with the details. He sighted the example of my having technical difficulties a few times on his service- for example, one day all my progress notes were listed in the system as consult notes. (I am completely inept with computers admittedly, and still don't completely understand how I managed to accomplish this uniquely stupid feat.) Then, I started worrying about how everyone must be talking about all my dirty laundry, etc etc. I tried to console myself with the fact that in this program, everyone talks **** about everyone, so this would hardly be a standout, even if true. Then, just today, I received my most positive round of evals all year from the attendings on that same service, which was also my most recent. I also got my evals from the previous month, which were a heck of a lot better than from October and before.

This is a filthier business than I ever thought... but wow, that little boost came just at the right time.

Dude. Chill. You are looking for reasons to be negative. The faculty are required to meet twice a year and talk about how residents are doing. At supportive programs, it happens more. Clearly there was a discussion and they asked this attending to be your mentor and help guide you and make you a better doctor. They want you to succeed. Stop trying to psych yourself out.

I imagine 1 of 2 things happened at the meeting (you should consider either a positive):
1) it was clear this attending was a strong supporter of yours and they trusted his judgement and asked him to help you as much as possible
OR
2) they collectively agreed you had deficiencies but were capable of improving and asked for someone to step up... and this attending volunteered

 

[Jaydid]

Thanks to all once again for the responses. Despite some of the support my program has showed, there is one thing that worries me. I absolutely accept that time management and organization are a struggle, and that low confidence causes me to stumble at the worst of moments. BUT, some of my bad evals have stuff on them that is absolute fiction. (Example: one tried to say that I wanted to take an unstable patient to CT and didn't know how to replace electrolytes. I learned how to do this the first week of residency, and obviously know better than to put an unstable patient in CT. I cannot remember a time when this came anywhere close to happening, nor was such an incident called to my attention before the written eval, 3 months after the rotation was complete.) Of course I know that I have to swallow these things with a "yes sir," and am smart enough not to make a fuss about the comments themselves. However, I worry about the motives behind literally making stuff up, and/or if there were incidents that lead to an attending thinking such things, why weren't they brought up in real time? I am concerned that such behavior is an attempt to pave the way to the door.

Just to pre-empt any comments about "lack of insight," please note that I'm not suggesting that I don't have problems. I'm simply questioning the motives behind listing events that in fact, did not happen. (Also note my previous post about receiving a poor eval from an attending that I hadn't even worked with.)

This leads me to the question: from a legal standpoint, is it advisable to sign terrible evals?

 

[shopsteward]

You seem to do a lot of worrying about hidden motives, but a lot of the actions you report (informal warning from your chiefs, APD warning about a possible need to repeat - which is better than probation - and attending offering to be a mentor) are in fact pretty supportive, and provided you make progress on the issues raised it seems likely that you will be helped to succeed in completing residency. Please keep in mind the positives that are there - it will help you get through successfully, rather than always looking for the worst interpretation. I haven't see any evidence in your posts to support a theory that there is a conspiracy to get rid of you.

As to inaccurate evaluations, they are not necessarily concocted with the motive of getting you out: even attendings make innocent mistakes. Your best bet for avoiding this is to keep in close contact with the people who will be writing your evaluations: if you are talking to your attendings regularly about what and how you are doing there is a better chance that they will bring up any issues they have at the time, and you can deal with them then (either querying the accuracy or agreeing how you can avoid such issues arising in the future) rather than having them come up months later when it is too late to either challenge or correct.

If you are asked to sign an evaluation you think is factually incorrect (rather than just expressing an opinion you don't agree with), you are in a tricky position. What you think is a factual inaccuracy could in fact be a difference of opinion or interpretation (was the CT patient stable or not? Was a question you asked about taking a patient to CT at some future time interpreted as a desire to take them to CT now when they were unstable?). Unless a patient record clearly shows that the comment is inaccurate (and be HIPAA careful about consulting patient records) there is not much you can do.

 

[NotAProgDirector]

This leads me to the question: from a legal standpoint, is it advisable to sign terrible evals?

I'm not sure what the point of this is. I'm not sure that it's worth making an argument about it, either. It depends upon whether there is some statement that you're signing -- i.e. does your signature demonstrate that you've reviewed it, or that you agree that it's an accurate assessment? If there is no statement that you're signing, and you're just "signing" it, it probably has no legal meaning. That said, you could simply write "reviewed" and sign.

We don't have residents do this, FYI.

 

[Jaydid]

A random question for those who have been the black sheep resident, (or hell, really anyone)-

How to deal with those mandatory social type events? It's not easy to know how to act Ari be those faculty that have clearly illustrated that they hate you on evals. All the same, there are plenty of journal clubs or whatnot, where it's expected that "all who aren't working be present." I'm sure they keep track of who has an excuse to be absent, so wouldn't dare not to show. My strategy so far has just been to try to hold my head high and be cordial, but oh, the awkwardness.


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[AdmiralChz]

How to deal with those mandatory social type events? It's not easy to know how to act Ari be those faculty that have clearly illustrated that they hate you on evals. All the same, there are plenty of journal clubs or whatnot, where it's expected that "all who aren't working be present." I'm sure they keep track of who has an excuse to be absent, so wouldn't dare not to show. My strategy so far has just been to try to hold my head high and be cordial, but oh, the awkwardness.

So, honestly I don't consider Journal Club a social thing - it's more of a mandatory program thing and you SHOULD ABSOLUTELY ATTEND if you are worried about your stance with the program. You don't want to give them ammunition against you. Show up, and even better think of some pointed discussion points about the paper that you can add. If not, then at least show up and be seen - programs take attendance at these things and unless you have a great reason for missing (e.g. emergency trauma in the OR) you should really try to be there. I know it's been a tough few months, but try to have a thicker skin when interacting with attendings and don't cower in fear when you see them outside of the traditional clinical setting. I'd really be surprised if they walk up to you and just start berating you.

I thought you'd ask more about social gatherings outside of work - like tailgates, dinners, etc... Like many have said previously, people tend to be more patient and more understanding with people they are friends with and enjoy being around. I would try to attend such things.