How does a resident fail a rotation

[doctorpurple]

I know I'm being paranoid but this wasn't discussed at all during orientation and I was just wondering reading from all the threads here. I'm a new intern who started in wards. I felt pretty awful and crappy some days for not knowing the answer to pimp question on rounds. I'm now in ED rotation and feeling better and maybe learning residency better. I'm just wondering how does one fail a rotation specifically in the military? I know each attending do some sort of evaluation but I haven't seen my evals yet for my first rotation and I'm worried. What if they put negative remarks on it? Does that mean I fail the rotation?

---

Members don't see this ad.

 

[pgg]

I know I'm being paranoid but this wasn't discussed at all during orientation and I was just wondering reading from all the threads here. I'm a new intern who started in wards. I felt pretty awful and crappy some days for not knowing the answer to pimp question on rounds. I'm now in ED rotation and feeling better and maybe learning residency better. I'm just wondering how does one fail a rotation specifically in the military? I know each attending do some sort of evaluation but I haven't seen my evals yet for my first rotation and I'm worried. What if they put negative remarks on it? Does that mean I fail the rotation?

People who fail rotations generally know before they leave. An intern being stumped by an attending' strong pimp voice in freakin' JULY is not unusual or likely even remembered more than 10 minutes later, unless he repeatedly says something totally off the wall.

I wouldn't sweat it. An intern who gets his work done and doesn't hurt anyone is a July success. Odds are you did fine, unless you got specific negative feedback.

 

[sonofva]

Dude my advice is to be honest and say you don't know. But then go look it up. Then try to bring it up with the attending of it if it comes up in the future. Also, don't be careless. The people I saw who failed rotations either showed literally no initiative, or were constantly making careless mistakes and putting patients at risk.

At this stage they expect you to know two things: jack and ****.

 

[Homunculus]

to me it generally comes down to work ethic and professionalism, and less medical knowledge for rotation failures.

it doesn't happen often, and its more students typically than residents who fail. some of this stuff is mind boggling-- showing up late chronically, phoning nurses to gather your morning round data, falling asleep chronically during lectures, skipping a day to console your grieving wife over the death of your cat, or falling asleep *during* patient encounters-- things that if you take a step back are blatantly obvious. work hard, don't lie, and be a team player is all we ask.

foundation of knowledge issues only bite people (well, with me at least) if i have gone through the process of teaching you and do a quick check a week or so later to see if you can recall (even if just the hight points of) what we discussed. if i spend 10-15 minutes going through some basics of inflammatory bowel disease, and a week later we're scoping and conversing about miscellaenous GI issues i expect at least a little of what we talked about to stick. not that i haven't seen some jaw dropping holes in people's education-- but when you start residency everyone has holes courtesy of their medical schools. so early on "i don't know" is fine. but if you are a senior resident a few months away from graduating and you don't know something that should be pretty basic-- that may be an issue. but by then failing a rotation is not going to scuttle your entire residency.

there has also been a huge paradigm shift in GME over the past decade catering more toward the learner. you should be getting feedback almost constantly. and if not, ask for it. a failing rotation should never be a surprise.

i recommend relaxing a bit, continuing to work hard and learn, and see how you feel in a year or so. chances are good you will be fine.

--your friendly neighborhood can you give me feedback on my feedback on your feedback caveman

 

[HighPriest]

Agreed with all of the above. As an intern, your job is to demonstrate that you are capable of learning and that you don't take unjustified risks. I personally don't care if you are able to answer most of my questions or not on the first go, but as mentioned I would start to get concerned if you demonstrated a lack of ability to retain information. You should sound like you've read about your patients, but you're not going to be an expert on basically any of their ailments because you're an intern. If you were an expert, you'd be a staff physician.

The residents I have known who were put on probation were in that position because:
1. They lied and covered it up.
2. They demonstrated a distinct lack of safe judgement - not just made a mistake, but repeatedly did things that were questionable or dangerous.
3. They demonstrated an inability to learn from their patients, their reading, their colleages, and their mistakes.

I have yet to meet a resident who was "pretty good" but just barely not good enough to pass a rotation. If residents start falling behind, but are salvagable, most attendings will swoop in and let you know where your deficiencies lay. But this isn't a written exam. You're not going to fail by one question. If you demonstrate ability, interest, and safety, you're going to pass.

Also, keep in mind that ACGME doesn't like to see a ton of residents on probation or failing. It reflects badly on the program. I wouldn't hang your had on that being a saving grace, but it does mean that there is some incentive to help you.

 

[Ziehl-Neelsen]

to me it generally comes down to work ethic and professionalism, and less medical knowledge for rotation failures.

Esto es verdad.

I primarily fail medical students/interns/residents for being liars, scumbags, or dangerously unreliable (read unorganized, forgetful, or overconfident) I rarely fail upper level residents for "fund of knowledge" or "technical proficiency" issues but have honestly never failed an intern or lower level resident for these issues.

No reasonable attending expects a new intern to know much or be competent at anything. I paraphrase The House of God, "Show me an intern who only triples my work and I will kiss his feet." Show up on time, follow through, stay organized, admit your mistakes, ask questions and clarify when unsure, ask for help, tell the truth, and get 1 of 10 pimp questions right and you'll be fine. As the Caveman noted, if you're getting basic things wrong and mismanaging things as an upper level, that's where the winnowing for "fund of knowledge"/ability issues comes into play.

I once had an intern argue with me (to the hilt I might add) that we shouldn't perform genetic testing on a placenta when trying to elucidate congenital disease because the placenta is genetically identical to the mother. I made it a point to find out where that intern had gone to medical school and what specialty he was going into, but I didn't fail him.

"Negative remarks" on your eval=poorly phrased constructive criticism or a hypersensitive intern (probably the latter). You'd know if you were being failed.

Ah July--the worst month of the year!

 

[Homunculus]

"Negative remarks" on your eval=poorly phrased constructive criticism or a hypersensitive intern (probably the latter). You'd know if you were being failed.

+1

and remember that an evaluation that doesn't give you something to work on or improve is not doing you any favors. unless you are the personification of dr. house or dr. osler reincarnate there should be *something* you can work on. evan as staff i have things i need to work on-- it never ends. so don't take the "negative remarks" so personally.

--your friendly neighborhood wasn't always so sagely back in his younger cavedoctor days intern caveman

 

[sonofva]

+1

and remember that an evaluation that doesn't give you something to work on or improve is not doing you any favors. unless you are the personification of dr. house or dr. osler reincarnate there should be *something* you can work on. evan as staff i have things i need to work on-- it never ends. so don't take the "negative remarks" so personally.

--your friendly neighborhood wasn't always so sagely back in his younger cavedoctor days intern caveman

Dr. Housler

 

[DrMetal]

I know I'm being paranoid but this wasn't discussed at all during orientation and I was just wondering reading from all the threads here. I'm a new intern who started in wards. I felt pretty awful and crappy some days for not knowing the answer to pimp question on rounds. I'm now in ED rotation and feeling better and maybe learning residency better. I'm just wondering how does one fail a rotation specifically in the military? I know each attending do some sort of evaluation but I haven't seen my evals yet for my first rotation and I'm worried. What if they put negative remarks on it? Does that mean I fail the rotation?

You won't fail the rotation for not knowing the answer to a pimp question. Don't know the seven different presentations of multiple endocrine neoplasia? Neither does anybody else. People like pimping to make themselves look smart.

You will fail the rotation for not doing what you were told to do. For instance: if you have to be told three times to order a medication or order a study, that's bad. You have to come up with a good system of writing down everything that needs to be done, prioritizing, and then executing.

And of course you will fail for not being professional (showing up late, not staying late enough, being rude etc.

 

[dr zaius]

You won't fail the rotation for not knowing the answer to a pimp question. Don't know the seven different presentations of multiple endocrine neoplasia? Neither does anybody else. People like pimping to make themselves look smart.

You will fail the rotation for not doing what you were told to do. For instance: if you have to be told three times to order a medication or order a study, that's bad. You have to come up with a good system of writing down everything that needs to be done, prioritizing, and then executing.

And of course you will fail for not being professional (showing up late, not staying late enough, being rude etc.

Pretty much this. The only interns I have known to fail a rotation were socially terrible and couldn't execute tasks.

 

[Gastrapathy]

It's just like the short story you recall from freshman English by Shirley Jackson. "Fail an intern in June, corn come soon."

 

[Shikima]

I thought an intern failing was more along the sacraficial scenes depicted in Apocalypto.

 

[jabreal00]

My expectations for interns regarding fund of knowledge is a fairly low bar. I expect them to know slightly more than the MSIII or MSIV. I do compare intern's fund of knowledge among their class so I'd make note if one cannot even answer basic questions. However, I wouldn't fail someone for poor fund of knowledge relative to their classmates. What I'd fail an intern for is lack of professionalism (yelling at nurses or being rude to patients, chronically late or not showing up), laziness or inability to follow directions. The primary goal of an intern is to learn. They are to learn to technical aspects of being a doctor, hence why their rotations is heavy on floor work. This is also the opportunity that they should be reading at every chance. Each patient is an opportunity to read about a specific disease process.

Now if it is June and an intern is 11 months into their residency and they still have a poor fund of knowledge, this is troubling.

 

[deuist]

From an emergency medicine perspective, the only things I expect a new intern to know are ACLS and dosages of medications for an intubation. Few things grind my gears more than someone who's been a doctor for three months asking to intubate one of my patients and when I ask, "What drugs are we going to use," all I get back are blank stares.

I have known one emergency medicine intern to be placed on probation and an internal medicine in turn to fail the entire year for fund of knowledge related deficiencies. In both cases neither was reading during the entire year. Nothing. Zip. Not up. Not one damn thing the entire year. For both of them, their lack of knowledge was clear from the very beginning and stayed a problem the entire year, despite multiple warnings from various attendings and upper-level residents.

 

[USUHSboardFail]

I have seen some that "fail out" of internship/residency and get sent out to the GMO land - Surgery and Medicine. About 70% were HPSP, compared to 30% USUHS. I am not sure what their options are - maybe family med in the future? Some are now angry with milmed and others are hoping for another chance after the militaryt...

 

[haujun]

quite frankly even without extra studying if you are awake and attend most of morning reports and education conference etc...your fund of knowledge should increase and pass the board with few weeks of studying. As for failing...I really wanted to fail one intern during CCU when I was senior resident. My attending warned me not to as I will be responsible for remediation training for that intern. LOL. Bottom line other that professional deficiencies such as lying etc...it is really hard to fail rotation.

 

[BetaAlpha89]

I have seen some that "fail out" of internship/residency and get sent out to the GMO land - Surgery and Medicine. About 70% were HPSP, compared to 30% USUHS. I am not sure what their options are - maybe family med in the future? Some are now angry with milmed and others are hoping for another chance after the militaryt...

For the people in the military I've seen fail out of internship it was due to Step 3 failures..but hopefully they find something else after GMO!

 

[backrow]

For the people in the military I've seen fail out of internship it was due to Step 3 failures..but hopefully they find something else after GMO!

You can't be a GMO without passing Step 3. No step 3 = no license = no GMO.

You won't fail out of internship for failing Step 3.


Sent from my iPhone using SDN mobile app

 

[BetaAlpha89]

You can't be a GMO without passing Step 3. No step 3 = no license = no GMO.

You won't fail out of internship for failing Step 3.


Sent from my iPhone using SDN mobile app

The intern I know was assigned 6 mths off, took and passed Step 3 second time, took the last two rotations of intern year, got a license then went on GMO. But N=1, so it may be different case to case. Thanks for clarifying though!

 

[backrow]

The intern I know was assigned 6 mths off, took and passed Step 3 second time, took the last two rotations of intern year, got a license then went on GMO. But N=1, so it may be different case to case. Thanks for clarifying though!

If they had six months off that means they had to repeat at least five of the months at the very least (if they were generous in calculating time away from the program). Given the half-story we've got so far I would bet there is a lot more to your example. Nobody does 5 months, takes six months off, completes the final 2 months and then graduates. Not even the most lax programs would get that past the institutional DIO, the Service's GME department or the ACGME RRC.

The Navy has a few Step 3 failures every year. 99% of them continue on with intern year and repeat the test soon thereafter and pass. It certainly doesn't look good on your GMESB application and if the failure occurs before the GMESB meets it can pretty much seal your fate to GMO if you were trying to go straight through. If you already had a straight through contract it won't cancel that out as long as you pass during the year.


Sent from my iPhone using SDN mobile app

 

[BetaAlpha89]

If they had six months off that means they had to repeat at least five of the months at the very least (if they were generous in calculating time away from the program). Given the half-story we've got so far I would bet there is a lot more to your example. Nobody does 5 months, takes six months off, completes the final 2 months and then graduates. Not even the most lax programs would get that past the institutional DIO, the Service's GME department or the ACGME RRC.

The Navy has a few Step 3 failures every year. 99% of them continue on with intern year and repeat the test soon thereafter and pass. It certainly doesn't look good on your GMESB application and if the failure occurs before the GMESB meets it can pretty much seal your fate to GMO if you were trying to go straight through. If you already had a straight through contract it won't cancel that out as long as you pass during the year.


Sent from my iPhone using SDN mobile app

Thanks for clarifying, there was a 6 month leave after the fail, but the intern may have had more time in rotations before GMO. But I was only there for two months rotating in the dept as a med student. The intern ended up deciding to GMO and finish military commitment before beginning a different civilian career.

 

[jabreal00]

I know I'm being paranoid but this wasn't discussed at all during orientation and I was just wondering reading from all the threads here. I'm a new intern who started in wards. I felt pretty awful and crappy some days for not knowing the answer to pimp question on rounds. I'm now in ED rotation and feeling better and maybe learning residency better. I'm just wondering how does one fail a rotation specifically in the military? I know each attending do some sort of evaluation but I haven't seen my evals yet for my first rotation and I'm worried. What if they put negative remarks on it? Does that mean I fail the rotation?

A knowledge deficit will not get an intern in July to fail a rotation. If you can't answer questions relative to your peers by 6-12 months that would be problematic. What would flag you for remediation or failure in July of your intern year is inability or unwillingness to follow directions. Negligence. Inappropriate behavior towards patients, nurses or other colleagues. Lying (better to say I don't know). As an intern, you're doing mostly flow work. You are conducting face to face interactions with patients, family and nursing staff. You are the reporter to your senior resident and attending. You implement (consults, order medications, replete electrolytes etc) the plan formulated by the resident and attending. You help facilitate care and disposition needs of the patient. These are crucial building steps one has to learn to be able to one day lead a team. You have to know how to grease the wheels.

 

[d2305]

Not letting your chief resident know a patient is hyponatremic can be a problem. He had to do an extra month of primary care, but graduated from starship (balboa).

 

[DD214_DOC]

A pgy2 stating they want to start lamictal at 200mg bid and being unable to answer your question of why that's a bad idea.

Not paging the senior resident or trauma team after a patient bent down and chargedran head first into a steel door and collapsed to the floor with LOC. (Same pgy2)

Allowing a manic pt access to his credit card and phone so he can order lobster and steak dinners for everyone on the unit. (Yep, same resident)




Sent from my iPhone using SDN mobile

 

[hello1234!]

A pgy2 stating they want to start lamictal at 200mg bid and being unable to answer your question of why that's a bad idea.

Not paging the senior resident or trauma team after a patient bent down and chargedran head first into a steel door and collapsed to the floor with LOC. (Same pgy2)

Allowing a manic pt access to his credit card and phone so he can order lobster and steak dinners for everyone on the unit. (Yep, same resident)

mobile

Omg ... ... and these are just the stories u know about ...

If he seriously couldn't come up with why starting lamical 200 bid is a bad idea, I don't think this resident should be prescribing anything. This is the one of the 3 examples that disturbs me the most but all 3 examples u mention are pretty terrible ... ...


Sent from my iPhone using SDN

 

[DrMetal]

Omg ... ... and these are just the stories u know about ...

If he seriously couldn't come up with why starting lamical 200 bid is a bad idea, I don't think this resident should be prescribing anything. This is the one of the 3 examples that disturbs me the most but all 3 examples

I'm ok with the lobster thing...

 

[Shikima]

I'm ok with the lobster thing...

 

[DD214_DOC]

Omg ... ... and these are just the stories u know about ...

If he seriously couldn't come up with why starting lamical 200 bid is a bad idea, I don't think this resident should be prescribing anything. This is the one of the 3 examples that disturbs me the most but all 3 examples u mention are pretty terrible ... ...


Sent from my iPhone using SDN

Oh, there are soo many more for this resident. During a case presentation in front of the entire department, admitted to visiting a sex shop downtown for one of her therapy patients. I forget why she went, but it didn't matter, because she openly admitted to everyone that she has incredibly poor boundaries with patients, absolutely no insight to realize she probably shouldn't openly admit it to the entire department, and is probably just a flat out *****.

She also got into some trouble for going to a patient's private residence to conduct a therapy session because the patient texted her on her private cell (again, terrible boundaries) and said her anxiety about coming to the hospital was too overwhelming and to come to the home to do it. For those who aren't psych, this is also terrible for many, many reasons, the least of which being that enabling avoidance of anxiety-provoking stimuli is the exact opposite of how you treat it.

Sadly, this resident was graduated by the program.

 

[DrMetal]

Oh, there are soo many more for this resident. During a case presentation in front of the entire department, admitted to visiting a sex shop downtown for one of her therapy patients. I forget why she went, but it didn't matter, because she openly admitted to everyone that she has incredibly poor boundaries with patients, absolutely no insight to realize she probably shouldn't openly admit it to the entire department, and is probably just a flat out *****.

She also got into some trouble for going to a patient's private residence to conduct a therapy session because the patient texted her on her private cell (again, terrible boundaries) and said her anxiety about coming to the hospital was too overwhelming and to come to the home to do it. For those who aren't psych, this is also terrible for many, many reasons, the least of which being that enabling avoidance of anxiety-provoking stimuli is the exact opposite of how you treat it.

Sadly, this resident was graduated by the program.

Was she hot?

 

[backrow]

Was she hot?

She was psych, not Derm.....draw your own conclusions


Sent from my iPhone using SDN mobile app

 

[DD214_DOC]

Was she hot?

Definitely not.