Help me turn things around

[gutonc]

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.

Some programs (Gen Surg and some of the surgical subspecialty programs where I did residency for example) will have "Journal Club" at a restaurant/bar or an attending's house so it's a combination social/academic function. And attendance was in fact mandatory.

As to how to handle it. Show up. If it's a JC or board review thing, be prepared. Chin up, head down. Don't make waves. Don't give anybody any rope to hang you with. Easy to say, hard to do. Good luck.

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[MediCane2006]

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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It sucks but you gotta be at all those events. Smile. Be enthusiastic. If it's journal club, make sure you are presenting an article. You have to keep your head up and try to shine as best you can.

You also need to realize that you are probably being harder on yourself than everyone else is. Yes, it's easy to assume everyone is talking about you behind your back. But EVERYTHING your program has done has indicated that they are trying hard to keep you. They are on your side and, having been on both sides of this situation, you need to accept their help and keep your focus on trying to excel rather than worrying about what people are saying about you.

 

[Gastrapathy]

Signing evals proves face to face feedback occurred. You are agreeing that you've seen it.

 

[Jaydid]

So, I just had my mid-year eval, and..wow. In a good way. I walked in terrified, because like I said, my PD has taken pretty obvious pleasure in kicking people while they're down in the past. The first thing he said to me was, "relax. This isn't going to be as bad as you think." He went on to say that he knew I was incredibly smart, but that we had to work on my "stage fright" and organizational skills. I completely agreed. He added in that he felt a couple of my faculty evals were inappropriately personal, and that one person in particular "always has issues with my demographic group- so actually her eval of you was good, relatively speaking, " and went on to make a joke about all the deplorable personalities one encounters in our specialty. (Really? I hadn't noticed.) He told me that while there were things to work on, there was no reason to think any of it was insurmountable, and that in particular, the attendings from my last rotation were all enthusiastically rooting for me.

So, the verdict is an "improvement plan," with details pending. He seemed to think it was unlikely that I'd have to repeat the year, and repeatedly told me there was no imminent danger of losing my spot in the program. (Of course, that's with the understanding that I have to comply with the improvement plan- only if that fails would he consider making me repeat.) For the benefit of others who might find themselves in a similar situation, apparently none of this is reportable. It's not probation or anything that any board needs to know about.

Furthermore, I asked my current attending for some mid-rotation feedback a week or so ago, and she simply responded by telling me I'm doing a great job and to keep up the good work.
She is an incredibly straight shooter, and we've had a lot of face time, so I actually don't think she was just trying to get rid of me.

Overall, I am utterly shocked, relieved, motivated and committed to making this work. Here's to new beginnings.

 

[evilbooyaa]

So, I just had my mid-year eval, and..wow. In a good way. I walked in terrified, because like I said, my PD has taken pretty obvious pleasure in kicking people while they're down in the past. The first thing he said to me was, "relax. This isn't going to be as bad as you think." He went on to say that he knew I was incredibly smart, but that we had to work on my "stage fright" and organizational skills. I completely agreed. He added in that he felt a couple of my faculty evals were inappropriately personal, and that one person in particular "always has issues with my demographic group- so actually her eval of you was good, relatively speaking, " and went on to make a joke about all the deplorable personalities one encounters in our specialty. (Really? I hadn't noticed.) He told me that while there were things to work on, there was no reason to think any of it was insurmountable, and that in particular, the attendings from my last rotation were all enthusiastically rooting for me.

So, the verdict is an "improvement plan," with details pending. He seemed to think it was unlikely that I'd have to repeat the year, and repeatedly told me there was no imminent danger of losing my spot in the program. (Of course, that's with the understanding that I have to comply with the improvement plan- only if that fails would he consider making me repeat.) For the benefit of others who might find themselves in a similar situation, apparently none of this is reportable. It's not probation or anything that any board needs to know about.

Furthermore, I asked my current attending for some mid-rotation feedback a week or so ago, and she simply responded by telling me I'm doing a great job and to keep up the good work.
She is an incredibly straight shooter, and we've had a lot of face time, so I actually don't think she was just trying to get rid of me.

Overall, I am utterly shocked, relieved, motivated and committed to making this work. Here's to new beginnings.

Good job. Always good to see a success story on these forums. Keep working hard and you'll make it.

 

[Bonferroni Correction]

So, I just had my mid-year eval, and..wow. In a good way. I walked in terrified, because like I said, my PD has taken pretty obvious pleasure in kicking people while they're down in the past. The first thing he said to me was, "relax. This isn't going to be as bad as you think." He went on to say that he knew I was incredibly smart, but that we had to work on my "stage fright" and organizational skills. I completely agreed. He added in that he felt a couple of my faculty evals were inappropriately personal, and that one person in particular "always has issues with my demographic group- so actually her eval of you was good, relatively speaking, " and went on to make a joke about all the deplorable personalities one encounters in our specialty. (Really? I hadn't noticed.) He told me that while there were things to work on, there was no reason to think any of it was insurmountable, and that in particular, the attendings from my last rotation were all enthusiastically rooting for me.

So, the verdict is an "improvement plan," with details pending. He seemed to think it was unlikely that I'd have to repeat the year, and repeatedly told me there was no imminent danger of losing my spot in the program. (Of course, that's with the understanding that I have to comply with the improvement plan- only if that fails would he consider making me repeat.) For the benefit of others who might find themselves in a similar situation, apparently none of this is reportable. It's not probation or anything that any board needs to know about.

Furthermore, I asked my current attending for some mid-rotation feedback a week or so ago, and she simply responded by telling me I'm doing a great job and to keep up the good work.
She is an incredibly straight shooter, and we've had a lot of face time, so I actually don't think she was just trying to get rid of me.

Overall, I am utterly shocked, relieved, motivated and committed to making this work. Here's to new beginnings.

That's great. It has seemed through your posts that they've been on your side (even when you've been too focused on the negatives).

It's a hard road but the best thing u can do is stay positive and hide any frustration or resentment. It sounds like you've done that. It's no small feat and it isn't over yet. Especially once out of the doghouse, be sure to keep your chin up and head down as you grind out the rest of residency. Without exaggeration, the wellbeing of you and your family depends on it.

I am thrilled to hear this. Great work

 

[Jaydid]

Further update: I met with my mentor today, which made me feel even better about everything. He too reassured me that there is no imminent danger of losing my spot- he seemed to think that my harshest critics were spawned by things such as my computer ineptitude and taking too long to do certain things in the name of over-attention to detail (totally guilty of this.) He told me that he thought my knowledge and technical skills were above average, and that his colleagues from that rotation (my most recent) agreed. He also let me in on some pretty ugly truths about how the evaluation process works, which I think everyone in residency should know about.

Apparently, there is a yearly faculty meeting. This is an open forum for any and all attendings, during which each and every resident is discussed one by one. According to my mentor, these meetings get fairly out of hand and turn into "feeding frenzies, " much like our M&M's, if not worse. Before you know it, the attending that you rounded with ONCE is convinced that you're the next coming of Satan himself. He made a point to say that nearly every resident in the program was thoroughly dragged through the mud. (Disheartening in a way, but misery loves company! )At the time of this meeting, my mentor and his colleagues didn't even know me yet. After working with me, they had a powwow of their own, agreed that the target on my back was undeserved, and set out to make things right. That's when my mentor stepped up and volunteered to be my mentor. He went to the PD, who agreed that my deficiencies were redeemable.

I am totally floored that these guys would stick their necks out for me like that. It adds a whole new level of determination and confidence. I only hope that I can return the favor one day.

 

[mvenus929]

Further update: I met with my mentor today, which made me feel even better about everything. He too reassured me that there is no imminent danger of losing my spot- he seemed to think that my harshest critics were spawned by things such as my computer ineptitude and taking too long to do certain things in the name of over-attention to detail (totally guilty of this.) He told me that he thought my knowledge and technical skills were above average, and that his colleagues from that rotation (my most recent) agreed. He also let me in on some pretty ugly truths about how the evaluation process works, which I think everyone in residency should know about.

Apparently, there is a yearly faculty meeting. This is an open forum for any and all attendings, during which each and every resident is discussed one by one. According to my mentor, these meetings get fairly out of hand and turn into "feeding frenzies, " much like our M&M's, if not worse. Before you know it, the attending that you rounded with ONCE is convinced that you're the next coming of Satan himself. He made a point to say that nearly every resident in the program was thoroughly dragged through the mud. (Disheartening in a way, but misery loves company! )At the time of this meeting, my mentor and his colleagues didn't even know me yet. After working with me, they had a powwow of their own, agreed that the target on my back was undeserved, and set out to make things right. That's when my mentor stepped up and volunteered to be my mentor. He went to the PD, who agreed that my deficiencies were redeemable.

I am totally floored that these guys would stick their necks out for me like that. It adds a whole new level of determination and confidence. I only hope that I can return the favor one day.

Your description is probably the clinical competency committee, and probably isn't done the same everywhere. I think at my program, the division directors or ones responsible for the rotation in each subspecialty are all members, and everyone who has had contact with the resident can submit an evaluation.

 

[Lessisless]

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.

Signing an evaluation or even an adverse action document only means you acknowledge receiving it, not that you agree with it. The actions you take/or don't take, as in appeal or not appeal, is what ultimately determines whether or not you "agree" with it. Even then, program and institutional policies typically outline ways for you to address evaluations and other program related matters.

 

[Jaydid]

Opinions please: as I said, my PD is in the process of making an "improvement plan" for me. Even though I've had a brief discussion with him about what I have trouble with, I don't know how much of an idea he has of the day-to-day specifics. I've been doing a lot of thinking about the times when I've gotten tripped up and boiled it all down to a small handful of specific problems and solutions. For example: I know I tend to jumble up details about which patients are on which drugs, especially since all 25 of my patients are usually obese, hypertensive diabetics with nary a patent vessel in their bodies. The way our lists print out renders them worthless, IMO- tiny font, totally jumbled and usually not up to date. I have combatted this problem by making my own list where I split up drugs by system, along with a few other tweaks, and have found it immensely helpful so far. I have also changed the way I go through orders in the morning... and so on.

I have to email PD for a meeting time anyway, and was considering including a brief list of specific difficulties and solutions I'm experimenting with. I want to show that I have insight, and also make sure that I get as much as possible out of this whole thing. (Obviously, I'd use more diplomatic wording than I have here.) I just want to make sure not to annoy him or give him ammunition if something were to go awry. Thoughts?

 

[mcl]

Opinions please: as I said, my PD is in the process of making an "improvement plan" for me. Even though I've had a brief discussion with him about what I have trouble with, I don't know how much of an idea he has of the day-to-day specifics. I've been doing a lot of thinking about the times when I've gotten tripped up and boiled it all down to a small handful of specific problems and solutions. For example: I know I tend to jumble up details about which patients are on which drugs, especially since all 25 of my patients are usually obese, hypertensive diabetics with nary a patent vessel in their bodies. The way our lists print out renders them worthless, IMO- tiny font, totally jumbled and usually not up to date. I have combatted this problem by making my own list where I split up drugs by system, along with a few other tweaks, and have found it immensely helpful so far. I have also changed the way I go through orders in the morning... and so on.

I have to email PD for a meeting time anyway, and was considering including a brief list of specific difficulties and solutions I'm experimenting with. I want to show that I have insight, and also make sure that I get as much as possible out of this whole thing. (Obviously, I'd use more diplomatic wording than I have here.) I just want to make sure not to annoy him or give him ammunition if something were to go awry. Thoughts?

I wouldn't be too aggressive. Set the meeting, see what the PD has to say and what the "improvement plan" actually is. Meet with your mentor to review it. Suggest additional areas to your mentor and see if he thinks the improvement plan needs to be expanded. But when you initially meet with the PD, don't even hint that you think the wrong concerns are being targeted. Let your mentor fight that battle if it's something that needs fighting. You say, "thank you for this opportunity--I won't let you down" (or something along those lines).

 

[ThoracicGuy]

Opinions please: as I said, my PD is in the process of making an "improvement plan" for me. Even though I've had a brief discussion with him about what I have trouble with, I don't know how much of an idea he has of the day-to-day specifics. I've been doing a lot of thinking about the times when I've gotten tripped up and boiled it all down to a small handful of specific problems and solutions. For example: I know I tend to jumble up details about which patients are on which drugs, especially since all 25 of my patients are usually obese, hypertensive diabetics with nary a patent vessel in their bodies. The way our lists print out renders them worthless, IMO- tiny font, totally jumbled and usually not up to date. I have combatted this problem by making my own list where I split up drugs by system, along with a few other tweaks, and have found it immensely helpful so far. I have also changed the way I go through orders in the morning... and so on.

I have to email PD for a meeting time anyway, and was considering including a brief list of specific difficulties and solutions I'm experimenting with. I want to show that I have insight, and also make sure that I get as much as possible out of this whole thing. (Obviously, I'd use more diplomatic wording than I have here.) I just want to make sure not to annoy him or give him ammunition if something were to go awry. Thoughts?

One thing I found helpful was to use note cards. I would have the name, brief pmh, meds, etc at the top and then each day write down vitals, labs, and plans. This helped me to start organized and if an attending had a question, I would be able to quickly turn to the card and be able to answer the question.

 

[Jaydid]

Met with PD again today: the "plan" consists of weekly check-ins with attendings, during which they'll have to write a quick review, including some things they'd like to see me work on, with a specific focus on organization. Part of the goal is to prevent people from being perfectly sweet to my face and then digging in their claws on the eval months later- a reasonable goal. This is fine with me except for the fact that I'm pretty much going to have to call attention to the fact that I'm the black sheep repeatedly, so I worry about my reputation preceding me. Surprisingly, my PD seems to think that I might get pushback from faculty who might refuse to participate because they don't want to be bothered. He asked if I wanted him to preface it with the faculty before I start each new rotation. I said no, I'll tell them myself and contact him if I really do get pushback. (This way, I have at least some control over how it's presented, AND can let them get to know me for at least a day or two before dropping the bomb.) He went on to comment on how the 2 attendings I have next month are real dinguses. Um... thanks? Looking forward to it... sir? (I have to admit, their behavior at conferences wouldn't fly in most jobs... or most kindergartens, for that matter.)

I can't tell you how many people have made references to the essay "Swimming with Sharks" during this whole mess. Now, I know I'm new at this, but does anyone besides me think it's an enormous problem that attendings who are supposed to be caring for patients and mentoring us are compared to flesh-eating beasts, and it's considered totally acceptable, and an "occupational hazard?" I feel like the air is clearing, I've turned a corner and have a fairly good grasp on what I need to do to improve. Sometimes though, I just have to shake my head and ask how on earth I got mixed in with such a batsh*t crazy group of people.

 

[mvenus929]

At my program, they recommend doing weekly feedback with the attendings anyway, so you getting weekly check-ins wouldn't be that much different.

 

[nidusiamnot]

Have you considered getting evaluated for anxiety from a counselor or psychiatrist? I feel your program have gone above and beyond to keep you afloat. This probably means you have significant potential. You need to work on your self confidence, it's easier said than done but feeling wounded over criticism (constructive or otherwise) will only impede your efforts to succeed. I feel talking to a mental health professional has no drawbacks, especially if you do it on your own time.

 

[Jaydid]

Update: I made it! PGY-2 contract safe and sound, schedule secured. All of these evals motivated another handful of attendings to rally in my favor. If there's an upside to all of this, it's that the attendings who have helped me out are honestly like family to me now. Just trying to think of it now as getting through that next consult, next presentation, next day, etc. and trusting that I can get through one step at a time.

 

[ThoracicGuy]

Update: I made it! PGY-2 contract safe and sound, schedule secured. All of these evals motivated another handful of attendings to rally in my favor. If there's an upside to all of this, it's that the attendings who have helped me out are honestly like family to me now. Just trying to think of it now as getting through that next consult, next presentation, next day, etc. and trusting that I can get through one step at a time.

Great news. Thanks for giving us the update. Make sure you don't take this time to start slacking.