Resident Corrective Action/Probation

[Warped Apostle]

Hello everyone. I wanted to start a thread on the subject of Resident Corrective Action or Residency Probation. Last year I was placed on one by my program. There wasn't much information on the subject and I thought it could be helpful to start the conversation to provide a resource for residents that find themselves in this unfortunate situation. I am happy to share my experience.

I was in a PGY4 in a surgical subspecialty at a high volume academic center on the east coast. From the time I arrived, I was unhappy. The work was hard, but I was very unhappy and always felt like I didn't fit in with the other residents. I had a baseline understanding that residency is difficult and was determined not to give up in the hope that things would get better. Unfortunately after 4 years, they did not and the mental wear and tear was showing in my work. In Sept was placed on a resident corrective action (RCA). This came as a shock to me because I never showed up late, drunk, or high. No patients were harmed and I tried to be an amicable team player. I was told that I was not progressing and that I had communication and attention to detail issues. I was presented with a document that outlined everything I had done wrong (this was really hard to stomach). It also listed the rules on how to proceed and would be fired if violated. The possible outcomes of the RCA included to pass, repeat a year, or non-renewed/fired. I then had to sign the document acknowledging it.

When confronted with a challenge in medicine, the natural tendency is not to quit, but to work harder. And so I worked hard to address the feedback. As part of the program I had to meet with employee health, a psychologist, counselors, resident and faculty mentors, perform journaling, and underwent a mock oral administered by a third party physician to prove my clinical competence in addition to my clinical responsibilities. From my understanding there were no significant red flags from these inquiries. The verdict of the RCA in Feb was to continue it until May. When May came, there was no agreement on how to proceed. In June I found out that my contract was not going to be renewed.

Despite the result, I left the program on good terms and applaud them for putting in the resources to try to help me. Ultimately it wasn't a good fit and I was too stubborn to admit that I should quit. I found out that at my institution a few other surgical residents were placed on RCA with a similar result. Looking back on it, I felt like the option to non-renew was not realistically conveyed to me and in fact downplayed. If I had suspected this outcome, I probably would have prepared more to transfer or switch specialities.

My advice to anyone placed on residency probation is to start looking at switching programs or specialties no matter how unlikely it is to be non-renewed. Also look at the specifics fo the document in that are the complaints generalized or specific. If it's specific (like poor sign out communication) you probably have a better chance to address it, unlike generalized problems (like poor communication). Also always be nice and professional during the probation. It doesn't do any good to burn bridges because other programs will need recommendation letters from your current programs.

Remember you are not alone and we are here for each other.

---

Members don't see this ad.

 

[DrMetal]

I was presented with a document that outlined everything I had done wrong (this was really hard to stomach).

Which was what? Something (or somethings) must've triggered this.

My advice to anyone placed on residency probation is to start looking at switching programs or specialties no matter how unlikely it is to be non-renewed.

The only part of your post that I disagree with. Better advice would be to correct yourself and finish your residency at the program you're in now.

 

[GoSpursGo]

The only part of your post that I disagree with. Better advice would be to correct yourself and finish your residency at the program you're in now.

I think his point was it's not a bad idea to start considering plan B just in case. Clearly he tried his best to correct the problem, but wasn't successful, and so it's always a good idea to start on a backup plan.

 

[DrMetal]

I think his point was it's not a bad idea to start considering plan B just in case. Clearly he tried his best to correct the problem, but wasn't successful, and so it's always a good idea to start on a backup plan.

Well, sure. But considering that it's hard to switch programs even when you're on good terms, and switching specialties would require you to withdraw and re-apply in ERAS....and considering that switching programs doesn't necessarily make your deficiencies go away . . .the easiest path probably is to fix yourself and finish where you are.

Having said that, you're right, no problem with having a backup plan. Mine's is to quit this btch and become a heavy metal guitarist.

 

[asdfkljasdflkjasdflkj]

I suspect that sometimes the program is out to get you, and then they are just going through the motions to get you out of there. I suspect this is particularly true for a surgical program, where around pgy4 people start to realise that a resident will be able to operate independently in just 2 short years.

If you believe that you are being rail-roaded it would definitely be a good idea to have a plan B while attempting to stay in your program.

 

[DrMetal]

I suspect that sometimes the program is out to get you,

au contraire @asdfklj (great handle, how are you a +2 year user if this is your first post?)

It is a common myth that a program is 'out to get you'. Sure it could be true, but the firing of a resident never looks good for a program. Most want to see you graduate. Truth be told, most programs graduate way more subpar residents than they should, I only wish they fired more often. They don't. You've gotta try pretty hard to get fired.

start to realise that a resident will be able to operate independently in just 2 short years.

also not true. They don't give a damn what you do once you graduate and are independent. Then you're on your own, for better or worse, and your actions are no longer reflective of the program.

 

[Logi9]

Actually this is common in residency programs & workplaces across the country. Unfortunately you can come across supervisors who at worst may be toxic or don’t have time available to provide coaching/support to you. Often they feel that your best option is to leave the workplace. More protections need to be in place for residents in training who are vulnerable due to their position. I wish CIR (resident/fellow union) was available to all training programs.

 

[deleted480308]

Actually this is common in residency programs & workplaces across the country. Unfortunately you can come across supervisors who at worst may be toxic or don’t have time available to provide coaching/support to you. Often they feel that your best option is to leave the workplace. More protections need to be in place for residents in training who are vulnerable due to their position. I wish CIR (resident/fellow union) was available to all training programs.

I’ve seen more who should be fired and weren’t than those unjustly let go, maybe you have a different experience

 

[Logi9]

I have plenty of examples, even of physicians placed on probation for minor issues due to a disorganized and understaffed clinic. I read your post. What examples have you seen? I mean if you observed as a resident (incl. as a chief) you probably were only aware of half the story.

Directed to everyone: Can we have empathy and allow trainees to have some breathing room when these situations like these arise ? If they have a crisis (medical, family, etc -which has happened) or can improve a deficiency why not allow them to complete training? At the very least ensure due process for them.

You will inevitably face struggles in life, just like your patients- if you can’t exercise support for others then what are you doing in the medical field?

 

[DrMetal]

I have plenty of examples, even of physicians placed on probation for minor issues due to a disorganized and understaffed clinic. I read your post. What examples have you seen? I mean if you observed as a resident (incl. as a chief) you probably were only aware of half the story.

It's certainly possible. putting on probation is also different from outright firing, the latter being much harder and requiring more documentation.

Most things are personality and professional issues. We're a weird, introverted bunch.

 

[Logi9]

I hear what you are saying -but from what the OP wrote about probation to non renewal ? I mean it seems very similar to outright firing.

Yes I agree with personality. It does go both ways unfortunately.

 

[operaman]

While I don’t know the specifics, OP I feel like your program let you down. It sounds like they were bringing pgy2 level problems to you when you were in your pgy4 year. Surgical training today - especially at a big academic center like yours - is very top heavy and it does seem like these remediation plans get thrust on people much later in the game. Programs that are very old school face this too as interns and junior residents may have very little face time with attendings until pgy4+ when they finally start noticing some issues. Some programs also have a head in the sand approach to problems early in ones training, just passing people along hoping someone else will fix the problem.

I hope your program does a post mortem on itself to see if they can spot trouble earlier when it’s sooooo much easier to fix.

 

[BoardingDoc]

Directed to everyone: Can we have empathy and allow trainees to have some breathing room when these situations like these arise ? If they have a crisis (medical, family, etc -which has happened) or can improve a deficiency why not allow them to complete training? At the very least ensure due process for them.

If someone has a deficiency that they can improve, they generally do and come off of the remediation plan. The remediation plan is the due process. It says here is problem X, you have time Y to fix it. If so, we're cool. If not, this won't work out. What alternative strategy would you suggest?

 

[Goro]

I suspect that sometimes the program is out to get you, and then they are just going through the motions to get you out of there. I suspect this is particularly true for a surgical program, where around pgy4 people start to realise that a resident will be able to operate independently in just 2 short years.

If you believe that you are being rail-roaded it would definitely be a good idea to have a plan B while attempting to stay in your program.

Everything I'd read from our wise SDN residents and attendings over the years tells me that residency programs go to the wall to salvage their residents, with the exception being if patient's lives are endangered, or if someone has been dishonest or has an inability to learn.

And having been on SDN for a long time, I've also seen too many tip of the iceberg stories from posters in difficult situations. The OP has hinted that there is more to the story by noting "I was presented with a document that outlined everything I had done wrong (this was really hard to stomach). "

 

[asdfkljasdflkjasdflkj]

I'm not saying that sometimes people don't deserve to be fired. All I'm saying is that I bet that deficient residents can sometimes slide under the radar in longer programs, especially as they begin to slide into a more independent role and their deficiencies become more noticable. It may be at that point that a program decides that you may be beyond salvaging, and begin formal firing processes (probation status). Once put under the microscope like this, it may be difficult to change things when everyone expects you to fail, especially with less probable reasons for probation (communication, professionalism) that can be hard to point to concrete improvements.

If that is the case, mentally preparing for a graceful exit plan may be the best option ("parting ways amicably with PD LOR: it just didn't work out") rather than forcing something that can't be fixed.

 

[Warped Apostle]

Glad to spark the discussion. Everyone's situation who undergoes probation is unique and dependent on a lot of factors (self, PD, program, staff, residents, family, etc) therefore with the paucity of information out there it is hard to make conclusions or see definitive themes. My goal in posting this is to let others going through the same thing that they are not alone.

In my situation, I probably should have left after PGY-1 but like many in the medical profession we don't quit we just work harder (think of Jimmy V's speech). But unfortunately despite being celebrated in society, some problems don't get better with more work/effort and it takes a toll on who you are as person. Not to mention the concept of sunken costs, which we shouldn't consider but lets face it in medicine, we all do. With a lot of introspection, my issues were with my personality in relationship to the environment. Neither were wrong or bad. Think of it like a relationship that just didn't work despite both parties trying to make it work. (The movie Marriage Story...haha). We just came to this conclusion later than most. I learned a lot from this experience and it has given me new insight on how to proceed.

I hope this serves inspiration to others in a similar situation that you will get through it, grow, and become a better version of yourself.

 

[Vandalia]

I’ve seen more who should be fired and weren’t than those unjustly let go, maybe you have a different experience

I would agree.

Especially in a specialty with a low number of residents (a surgical subspecialty), letting a resident go is a tremendous burden to the program and is not something done lightly. Finding an advanced resident is not easy, there is a tremendous disruption to clinical operations (even if they find a great PGY-5, s/he is going to be slow for a couple of months learning all the local details) - and that means lost money, and the program will have a negative reputation on the interview trail for years.

Granted, there are plenty of sleazy faculty members who may try to do a resident in for a wide variety of issues, but these are usually held in check for the reasons mentioned above. Now if you are at a place like the Cleveland Clinic with 50+ IM residents in a single year, letting someone go does not carry the same repercussions, but that is not what we are talking about here.

I have done a lot of hiring, and I have seen at least a hundred applications where I have thought, "How did a residency let this person graduate?" I have not seen many where I thought "Why did that residency program let that physician go?"

So what happens if you are in the situation of the original poster?

First, do not run away. This seems to be the biggest problem. If they say you have problems examining kids, search out as many pediatric patients as you can possibly find. If you are a radiology resident and they say you are behind with respect to procedures, try to do as many as possible. Unfortunately, human nature is to do the exact opposite, which can destroy your chances.

Second, as mentioned, if you receive such a warning, you are in trouble. The medical profession in general and graduate medical education in particular are designed with motivations that encourage ignoring problems. It is called the "ostrich algorithm" for problem solving. Every motivation for the program and the faculty is to say that everything is fine with all the residents. If they reach the step of a formal warning it is incredibly significant, and you need to treat it as such. You also need to do some serious soul-searching. I guarantee you will want to say it is a "personality conflict" or something like that. It isn't. Re-read everything I have written. You need to decide the reason for the issue; can it be changed; and can it be changed at this program?

For example, lets say that you lost a child earlier in the year and that effected your performance. Perfectly understandable. There is reason to believe that your performance will improve as time passes. Perhaps your spouse is constantly berating you because he can't stand the location you are in. This does not mean you are not cut out for the specialty, but perhaps a different location might help.

Or you are simply not cut out for the specialty. I have seen this with some surgeons and specialties that are heavy in procedures. You might be an excellent clinician, you might have mastered all the techniques, you may have aced the in-service exams. But when the heat is on as a senior resident you freeze. When everything is going against you, you can't get the operation completed. If this is the case, you likely will not graduate. Even worse, if you do graduate those same problems will come and bite you as a surgeon.

Basically, you need someone who will show you the truth.

 

[Logi9]

If someone has a deficiency that they can improve, they generally do and come off of the remediation plan. The remediation plan is the due process. It says here is problem X, you have time Y to fix it. If so, we're cool. If not, this won't work out. What alternative strategy would you suggest?

When I spoke of due process that was not in reference to the probation/remediation. That was for a residents who face dismissal. Grievances need to be reviewed in all programs but that is another post which I’m not getting into today.

Remediation may seem like a ‘due process’ but does not have objective/realistic standards depending on who wrote it. It is unfair and does not help the resident to ameliorate deficiencies. How would I fix that? Well it’s a false assumption that all programs operate in the same way. If the program runs great and faculty who write these probation proposals are fair and realistic then that’s wonderful. I hope other programs can get on the band wagon.

If I had the ability to change things: I would create committee made up of experienced faculty from all programs and have them be the ones to review the probation requirements and the progress of the resident. Even add in a resident advocate or ADA rep if needed. It would greatly ensure the process was ‘more fair’ to both parties, lessen the bias, and protect the resident.
Or I would advocate for a union for residents or fellows. None of these work- I would tell the resident to lawyer up. If through all that the resident must leave.. then ok.

I’m on faculty. I get what you are saying, and right now I’m working with residents/fellows who have their own issues...However, I have witnessed multiple people who have had life struggles during their training years who were unfairly disadvantaged by the remediation process. It’s time to put in more checks and balances.

 

[FlowRate]

The residents I knew were on remediation plans when I was a chief resident were objectively terrible for a wide variety of reasons. Some of them actually did improve with focused help. Some didn't but were continued in the program anyway. It's hard to fire residents. Probably not as hard in surgical specialties where the standards and stakes are, in many ways, higher.

 

[Warped Apostle]

I know this thread has been inactive for a while but I wanted to circle back in order to close the loop. Following the RCA and dismal from my previous program, I applied to a different specialty and was able to match to a really strong institution closer to home. Looking back despite this being the "worst possible scenario" it actually turned out to be one of the best. I am happier and more fulfilled than I every was at my previous program. I wanted to encourage others who have had issues with their specialty or residency program that changing your situation is a viable option.

 

[SDF1]

Thank you for sharing your story. I had a similar situation happen to me and a very unsupportive program. It is an uphill battle but for those that are out there - continue fighting the good fight. You are not alone - many of us have gone through similar situations.

 

[Redpancreas]

I know this thread has been inactive for a while but I wanted to circle back in order to close the loop. Following the RCA and dismal from my previous program, I applied to a different specialty and was able to match to a really strong institution closer to home. Looking back despite this being the "worst possible scenario" it actually turned out to be one of the best. I am happier and more fulfilled than I every was at my previous program. I wanted to encourage others who have had issues with their specialty or residency program that changing your situation is a viable option.

Absolutely true. Switching residencies or fields is a viable option when you find yourself struggling mightily. Don't jump right to quitting residency and changing careers. Residents, Attendings, and Program Directors are all human. We pick at each other's mistakes for various reasons. With residency remediation/probation, below is what I recommend for those who find themselves in the position:

1.) When the concerns are first brought to your attention, take them very seriously and do your best to identify the severity level of the situation. Is this the introduction of a performance improvement plan (PIP) or is it an academic/professionalism probation? The former can oftentimes be manageed with deliberate/targeted efforts to improve the areas you were lacking in and hopefully have that reflect in the impressions of whoever thought you needed the plan and result in improved future evaluations.

2.) The period for reassessment of the situation is oftentimes 3 months (I suspect this is the interval clinical competency committees meet). At that point, if the remediation plan is not lifted, don't listen to whatever @@#$&* your advisor tries to tell you like "we need to wait a little longer to see improvement", etc. At this point, you know whatever the issue initially was that started this mess was not minor. It's actually quite difficult when under the microscope to change minds about performance and frankly you are now being held to a higher standard and being evaluated far more closely than any of the other residents. See #3

3.) If you get to this point (Probation OR Extended PIP Remediation Past 3 months) the only difference is really that probation is required to be on your transcript while extended remediation (PIP) is not but effectively both situations are hard to get out of. You may be eligible for up to 12 months total of PIP time. While that seems like all the time in the world, keep in mind only a few of your rotations really count and only a few opinions matter. You may have 10 good evals and 2 bad ones, but if the programs trusts the ones that were less than stellar, you're sunk. The goal of the remediation is also a moving target because you need to not only remedy your deficiciences, but catch up to wherever everyone else is at by the end of the 12 months. It's not an easy thing to do and most often, it's not just a matter of working harder. For this reason, you need to make it a point to meet with your program director. If you feel like there is something major you want to voice, now is the time to do it. When you meet with them, you need to tell them you are really putting your best effort forth and will absolutely continue to do so and hope that will reflect in your evaluations but you also want to walk through alternative options. Try to develop a collaborative relationship with the PD and others willing to support you. Sometimes the PD may be more realistic than others be willing to tell you the remediation's not really panning out and is willing to write you a letter to transfer residencies while you are still in good standing. If not that, if worst to worst hopefully that relationship will help convince the PD to write a SUPPORTIVE LOR for something else that you see yourself doing whether that's the same residency, a different field, etc. Like mentioned above, never argue with impressions because it's 100% subjective and the PD isn't interested in hearing it. It honestly just burns bridges and no one is listening with the aim of changing anything.

#3 has the potential to save you year(s) of wasted training.I am not trying to preach for a nihilistic outlook towards remediation. Nothing I write here is telling you to give up or not do your absolute best. Do absolutely that. The fact of that matter though is that oftentimes, when an impression is anchored into someone's minds (particularly if that person has clout with the clinical competency committee), it's not easy to change and that person will cognitively do more to find more flaws to justify his or her initial impressions than try to see what you're doing right or have improved. Yes, there are some cases where residents perhaps have no business practicing medicine and those are often apparent to everyone and is unfortunately the image that comes to mind when someone mentions a struggling resident. Many far more nuanced cases do exist than this forum likes to acknowledge. The difference between the "struggling" resident about to be non-renewed and "rockstar" resident nominated to be chief is narrower than many would think unless they actually find themselves in this sort of situation.

 

[Iamnew2]

I have plenty of examples, even of physicians placed on probation for minor issues due to a disorganized and understaffed clinic. I read your post. What examples have you seen? I mean if you observed as a resident (incl. as a chief) you probably were only aware of half the story.

Directed to everyone: Can we have empathy and allow trainees to have some breathing room when these situations like these arise ? If they have a crisis (medical, family, etc -which has happened) or can improve a deficiency why not allow them to complete training? At the very least ensure due process for them.

You will inevitably face struggles in life, just like your patients- if you can’t exercise support for others then what are you doing in the medical field?

Agree. In Medicine it's not infrequent to have a toxic culture - where on the one hand kindness and compassion for patients is supported but trainees/doctors are treated with harshness.

 

[twospadz]

As soon as a program gets you evaluated by a psychiatrist and places you on probation, they are 100% going to non-renew you. They are just going through the motions so they won’t be sued. If anyone is in this situation, start looking for programs ASAP. That’s my advice.

 

[Fano]

... after 4 years,... In Sept was placed on a resident corrective action (RCA). This came as a shock to me ...

If OP truly was not given any negative feedback for 4 yrs prior, then the people who run this program are grossly incompetent at managing people and should be fired. An RCA should never come as a surprise.

 

[Bollinger_MD]

(1) If you have not personally been in this situation yourself, than you will never be able to understand how substantially the cards are stacked against residents who do not have a healthy learning and working environment with which to complete their training.

All personality, qualification, and life issues aside; if your faculty are spending more time and energy trying to document your shortcomings than to teach, you will constantly be subjected to a hostile working environment that does not place any priority on your education.

(2) The safeguards that should protect residents from illegal activities by their programs are rarely implemented early enough to salvage a resident’s training in the same specialty. As medical students, we learned how to put our heads and work hard, not meticulously document the failures of everyone around us. If you are in a program like that, you should get out as fast as you can.

(3) GME is broken. It has become too complex for many of the leaders within the ACGME and its member organizations(AMA, AAMC, FSMB…) to keep up with the many intricacies associated with a training program that is seen both as part of your education and employment. The mud gets thick past and like has been said before, people are more likely to avoid getting involved than to try and fix it.

 

[Bollinger_MD]

The residents I knew were on remediation plans when I was a chief resident were objectively terrible for a wide variety of reasons. Some of them actually did improve with focused help. Some didn't but were continued in the program anyway. It's hard to fire residents. Probably not as hard in surgical specialties where the standards and stakes are, in many ways, higher.

Statistics would argue that it’s not really that hard to fire residents.

Since the 1980 SCOTUS ruling in Horowitz v Missouri that said they would not intervene on issues of academic deficiency, residents have routinely been coerced to resign amidst hostile working conditions and manufactured concerns about a resident’s professionalism, communication skills, academic deficiencies, etc.

If you agree to resign, you forfeit any chance to hold your former program accountable. If you don’t, you face a seemingly insurmountable task trying to defend your career, reputation, etc.

Unless you have been the victim of this tragedy, you will never know how awful it is. I wouldn’t wish it on my worst enemy.

 

[j4pac]

While I don’t know the specifics, OP I feel like your program let you down. It sounds like they were bringing pgy2 level problems to you when you were in your pgy4 year. Surgical training today - especially at a big academic center like yours - is very top heavy and it does seem like these remediation plans get thrust on people much later in the game. Programs that are very old school face this too as interns and junior residents may have very little face time with attendings until pgy4+ when they finally start noticing some issues. Some programs also have a head in the sand approach to problems early in ones training, just passing people along hoping someone else will fix the problem.

I hope your program does a post mortem on itself to see if they can spot trouble earlier when it’s sooooo much easier to fix.

This I can completely buy. It doesn’t take 3+ years to see that a resident is struggling with work flow, organization, communication, etc. If there were big mistakes...I can see that as a reason. Or if there was a significant concern about autonomy that may have not been there the previous years...ok, understandable. OP...we’re you told the concerns before your PGY-4 year?

 

[Warped Apostle]

Absolutely true. Switching residencies or fields is a viable option when you find yourself struggling mightily. Don't jump right to quitting residency and changing careers. Residents, Attendings, and Program Directors are all human. We pick at each other's mistakes for various reasons. With residency remediation/probation, below is what I recommend for those who find themselves in the position:

1.) When the concerns are first brought to your attention, take them very seriously and do your best to identify the severity level of the situation. Is this the introduction of a performance improvement plan (PIP) or is it an academic/professionalism probation? The former can oftentimes be manageed with deliberate/targeted efforts to improve the areas you were lacking in and hopefully have that reflect in the impressions of whoever thought you needed the plan and result in improved future evaluations.

2.) The period for reassessment of the situation is oftentimes 3 months (I suspect this is the interval clinical competency committees meet). At that point, if the remediation plan is not lifted, don't listen to whatever @@#$&* your advisor tries to tell you like "we need to wait a little longer to see improvement", etc. At this point, you know whatever the issue initially was that started this mess was not minor. It's actually quite difficult when under the microscope to change minds about performance and frankly you are now being held to a higher standard and being evaluated far more closely than any of the other residents. See #3

3.) If you get to this point (Probation, Extended Remediation Past 3 months) the only difference is really that probation is required to be on your transcript while extended remediation (PIP) is not but effectively both situations are hard to get out of. You may be eligible for up to 12 months total of PIP time. While that seems like all the time in the world, keep in mind only a few of your rotations really count and only a few opinions matter. You may have 10 good evals and 2 bad ones, but if the programs trusts the ones that were less than stellar, you're sunk. The goal of the remediation is also a moving target because you need to not only remedy your deficiciences, but catch up to wherever everyone else is at by the end of the 12 months. It's not an easy thing to do and most often, it's not just a matter of working harder. For this reason, you need to make it a point to meet with your program director. If you feel like there is something major you want to voice, now is the time to do it. When you meet with them, you need to tell them you are really putting your best effort forth and will absolutely continue to do so and hope that will reflect in your evaluations but you also want to walk through alternative options. Try to develop a collaborative relationship with the PD and others willing to support you. Sometimes the PD may be more realistic than others be willing to tell you the remediation's not really panning out and is willing to write you a letter to transfer residencies while you are still in good standing. If not that, if worst to worst hopefully that relationship will help convince the PD to write a SUPPORTIVE LOR for something else that you see yourself doing whether that's the same residency, a different field, etc. Like mentioned above, never argue with impressions because it's 100% subjective and the PD isn't interested in hearing it. It honestly just burns bridges and no one is listening with the aim of changing anything.

#3 has the potential to save you year(s) of wasted training.I am not trying to preach for a nihilistic outlook towards remediation. Nothing I write here is telling you to give up or not do your absolute best. Do absolutely that. The fact of that matter though is that oftentimes, when an impression is anchored into someone's minds (particularly if that person has clout with the clinical competency committee), it's not easy to change and that person will cognitively do more to find more flaws to justify his or her initial impressions than try to see what you're doing right or have improved. Yes, there are some cases where residents perhaps have no business practicing medicine and those are often apparent to everyone and is unfortunately the image that comes to mind when someone mentions a struggling resident. Many far more nuanced cases do exist than this forum likes to acknowledge. The difference between the "struggling" and "rockstar" resident nominated to be chief is narrower than many would think unless they actually find themselves in this sort of situation.

This needs to be reprinted in stone! Thank you for sharing. I could have used this advice earlier! Ever thought of making this a Kevin MD or Doximity article?

 

[Vandalia]

Statistics would argue that it’s not really that hard to fire residents.

Since the 1980 SCOTUS ruling in Horowitz v Missouri that said they would not intervene on issues of academic deficiency, residents have routinely been coerced to resign amidst hostile working conditions and manufactured concerns about a resident’s professionalism, communication skills, academic deficiencies, etc.

If you agree to resign, you forfeit any chance to hold your former program accountable. If you don’t, you face a seemingly insurmountable task trying to defend your career, reputation, etc.

Unless you have been the victim of this tragedy, you will never know how awful it is. I wouldn’t wish it on my worst enemy.

There is absolutely no motivation for a program to fire a resident unless they are completely incompetent or engage in illegal activities or expose the program to liability (e.g., severe sexual harassment).

Due to the reduced productivity, that is money out of the faculty members pockets and a whole lot of extra work; neither of which they want to do.

For every one resident who is let go, you can easily find a hundred who should have been.

Again, residencies never let residents go unless they have absolutely no choice.

 

[hallowmann]

There is absolutely no motivation for a program to fire a resident unless they are completely incompetent or engage in illegal activities or expose the program to liability (e.g., severe sexual harassment).

Due to the reduced productivity, that is money out of the faculty members pockets and a whole lot of extra work; neither of which they want to do.
...
Again, residencies never let residents go unless they have absolutely no choice.

To be blunt, this portion of the post is simply not accurate. I have witnessed up close and personal a specific program dismiss multiple people who did not fit this. Personality clashes were certainly a component, and remediation plans were fraught with vague criticism, nitpicking and punitive action, which was seen more as a way to make a case for dismissal or non-renewal rather than truly teach or bring the residents up to speed.

The way the department got around "money out of faculty pockets" was by simply pushing all the work onto the remaining residents, increasing call, extending clinic time, double booking, pulling residents from elective time to cover clinic "for the sake of the patients", etc. The only ones that truly experienced the loss of the residents, were other residents.

When lawsuits were threatened by former residents, University GME stepped in, replaced key program leadership, and the program has magically gone from losing a resident every year to having full classes year after year with real remediation plans that actually helped residents excel when they were struggling.

I agree that in many cases some residents go further along than they should or complete programs when they shouldn't, but that doesn't somehow make every single termination just, fair, or necessary, and it certainly doesn't make terminating a resident that difficult for the program.

 

[Warped Apostle]

There is absolutely no motivation for a program to fire a resident unless they are completely incompetent or engage in illegal activities or expose the program to liability (e.g., severe sexual harassment).

Due to the reduced productivity, that is money out of the faculty members pockets and a whole lot of extra work; neither of which they want to do.

For every one resident who is let go, you can easily find a hundred who should have been.

Again, residencies never let residents go unless they have absolutely no choice.

This is exactly what I thought, but I was wrong. Lesson learned.

 

[Warped Apostle]

I ended up writing an article on residency probation in an effort to help others going through a similar situation.

How to navigate residency probation

Understand that on a larger scale, whatever decision you choose will be the correct one and will lead you on a path to become a better person in ways you would not have predicted. Sometimes the worst situations in our lives can also lead to the best ones.

www.kevinmd.com

 

[Iamnew2]

I ended up writing an article on residency probation in an effort to help others going through a similar situation.

How to navigate residency probation

Understand that on a larger scale, whatever decision you choose will be the correct one and will lead you on a path to become a better person in ways you would not have predicted. Sometimes the worst situations in our lives can also lead to the best ones.

www.kevinmd.com

I ended up writing an article on residency probation in an effort to help others going through a similar situation.

How to navigate residency probation

Understand that on a larger scale, whatever decision you choose will be the correct one and will lead you on a path to become a better person in ways you would not have predicted. Sometimes the worst situations in our lives can also lead to the best ones.

www.kevinmd.com

What ended happening with your situation? Maybe I missed it. Did you finish your training successfully? But good for you for using your experience to encourage others and try to shed light on an obscure process.


I particularly loved this line that you wrote, "Sometimes the worst situations in our lives can also lead to the best ones. Besides, the most interesting people never took a linear path."

Amen to that!

 

[Helpful Troll]

What ended happening with your situation? Maybe I missed it. Did you finish your training successfully? But good for you for using your experience to encourage others and try to shed light on an obscure process.


I particularly loved this line that you wrote, "Sometimes the worst situations in our lives can also lead to the best ones. Besides, the most interesting people never took a linear path."

Amen to that!

See post #20 above

 

[Iamnew2]

See post #20 above

Thanks! Glad it worked out for OP.

 

[FlowRate]

I ended up writing an article on residency probation in an effort to help others going through a similar situation.

How to navigate residency probation

Understand that on a larger scale, whatever decision you choose will be the correct one and will lead you on a path to become a better person in ways you would not have predicted. Sometimes the worst situations in our lives can also lead to the best ones.

www.kevinmd.com

Overall good advice. The one thing I'd note is that people might think "the odds are stacked against you" implies that all residencies are malignant and not interested in changing their opinion. The PIP and probation cases I got to know about as a chief resident were due to severe resident under-performance and the program really went out of its way to try and help those residents improve. It was exceptionally rare for our program to move to actually terminating a resident. We certainly hear about notable negative experiences but the piece that's missing is all of the residents who successfully remediate (at least nominally...)

 

[Mass Effect]

I know this thread has been inactive for a while but I wanted to circle back in order to close the loop. Following the RCA and dismal from my previous program, I applied to a different specialty and was able to match to a really strong institution closer to home. Looking back despite this being the "worst possible scenario" it actually turned out to be one of the best. I am happier and more fulfilled than I every was at my previous program. I wanted to encourage others who have had issues with their specialty or residency program that changing your situation is a viable option.

Congratulations. I think what helped you substantially was your positive attitude. From your first post: "Despite the result, I left the program on good terms and applaud them for putting in the resources to try to help me. Ultimately it wasn't a good fit and I was too stubborn to admit that I should quit. I found out that at my institution a few other surgical residents were placed on RCA with a similar result. Looking back on it, I felt like the option to non-renew was not realistically conveyed to me and in fact downplayed. If I had suspected this outcome, I probably would have prepared more to transfer or switch specialities."

I mean, applaud the program??? And despite not realizing the deficiencies they pointed out, you didn't resort to "it's not true, I'm being railroaded" and instead, you tried to fix them. You sound like a really mature person and someone who just wanted to do their best. It didn't work out for whatever reason, but I'd bet your program picked up on this too, and likely that was conveyed to your new place.

This isn't to say there aren't some malignant programs out there because there are, but 99% of the time, the resident who feels railroaded does really have deficiencies to straighten out. I think the process should be changed (more checks and balances as someone said above), but this poster handled it exactly the right way. Take your own inventory if this happens to you. Don't just jump on the "I'm being railroaded" bandwagon and assume everyone is out to get you.

 

[Warped Apostle]

What ended happening with your situation? Maybe I missed it. Did you finish your training successfully? But good for you for using your experience to encourage others and try to shed light on an obscure process.


I particularly loved this line that you wrote, "Sometimes the worst situations in our lives can also lead to the best ones. Besides, the most interesting people never took a linear path."

Amen to that!

Thank you! My contract was not renewed so writing this was a bit therapeutic. This even forced me to revaluate my career. I decided to switch specialities and matched to one that I fit in much better.

 

[Warped Apostle]

Congratulations. I think what helped you substantially was your positive attitude. From your first post: "Despite the result, I left the program on good terms and applaud them for putting in the resources to try to help me. Ultimately it wasn't a good fit and I was too stubborn to admit that I should quit. I found out that at my institution a few other surgical residents were placed on RCA with a similar result. Looking back on it, I felt like the option to non-renew was not realistically conveyed to me and in fact downplayed. If I had suspected this outcome, I probably would have prepared more to transfer or switch specialities."

I mean, applaud the program??? And despite not realizing the deficiencies they pointed out, you didn't resort to "it's not true, I'm being railroaded" and instead, you tried to fix them. You sound like a really mature person and someone who just wanted to do their best. It didn't work out for whatever reason, but I'd bet your program picked up on this too, and likely that was conveyed to your new place.

This isn't to say there aren't some malignant programs out there because there are, but 99% of the time, the resident who feels railroaded does really have deficiencies to straighten out. I think the process should be changed (more checks and balances as someone said above), but this poster handled it exactly the right way. Take your own inventory if this happens to you. Don't just jump on the "I'm being railroaded" bandwagon and assume everyone is out to get you.

Thank you for the kind words. 100% agree with your statement that the resident on probation has issues that need to be addressed and realizing them is a crucial step before trying to improve. After all it takes two to tango. The biggest obstacles are egos and emotions from both residents and programs.

 

[Warped Apostle]

I am going to do a podcast with KevinMD in the near future. I will post it in this thread, hopefully it will be helpful to those looking for answers.

 

[Iamnew2]

Thank you! My contract was not renewed so writing this was a bit therapeutic. This even forced me to revaluate my career. I decided to switch specialities and matched to one that I fit in much better.

Oh nice! Glad you matched again! What did you match in?

 

[Warped Apostle]

Oh nice! Glad you matched again! What did you match in?

Rads!

 

[Medin2016]

Rads!

Congratulations. Looking forward to your podcast. Can you share some steps and resources you have used to help you re-matched?

 

[Warped Apostle]

Congratulations. Looking forward to your podcast. Can you share some steps and resources you have used to help you re-matched?

Great question. I didn't really look or find many resources as it is a pretty specific predicament. I did a lot of soul searching in regards to what things do I like and not like about clinical medicine after having significant experience. I tried to find a specialty that fit those things and kept an open mind. I really leaned on my social network where I was able to find information and a mentor in the my new specialty. This was crucial. When applying I tried to contact and spoke with many alum of various programs to get the inside scoop, which I think helped me get interviews as they would reach out to the PD on my behalf.

 

[Warped Apostle]

Here is the podcast

How to navigate residency probation [PODCAST]

This anonymous physician resident shares his story and discusses his KevinMD article, "How to navigate residency probation."

www.kevinmd.com

 

[Medin2016]

question: if your residency contract not get renewed, or you choose to change a specialty, what is the best way to find another position? Re-register with ERAS or looking on Internet? Please provide your advice

 

[ThoracicGuy]

question: if your residency contract not get renewed, or you choose to change a specialty, what is the best way to find another position? Re-register with ERAS or looking on Internet? Please provide your advice

You should use any and all resources available. If you just recently finished medical school, I would try them as a resource. If you are wanting to change fields, talking with the local PD at your training location for those fields would be good. Of course, talking with trusted people in your current program can be helpful as well. If you have credit for training in your program, you can consider taking a spot outside the match starting in the 2nd year or later, depending on the field. ERAS is always an option as well, though you will need letters from people that have worked with you.

 

[Redpancreas]

question: if your residency contract not get renewed, or you choose to change a specialty, what is the best way to find another position? Re-register with ERAS or looking on Internet? Please provide your advice

1.) Meet with your current PD to salvage anything. Try for a letter of support. If they won't write you a letter of support for what you want, your match chances will kind of suck. If you wish to push past that, contact APDs and ask for their letters of support.

2.) Regardless of whether you are applying to the same or different field, your interview should/would be centered on what you learned about yourself at your prior program and what you will be doing differently. If you choose the same field, even with decent medical school performance/test scores, you will likely by default be ranked below applicants with step scores/medical school performance 2 SD lower than yours at programs you didn't even think to apply to the first time. Your extra experience doesn't count for much either because PDs are more risk averse and couldn't care about how much prior experience you have.

 

[SilverCat]

As someone who is about to be placed on probation, just want to know if anyone made it through this to have a successful medical career? I was in danger of probation per my PD previously due to repeated failure to complete paperwork,etc, and was now taken off a rotation after a brief period of time for issues not related to substance use or violent/inappropriate behavior.