Terminating residents

[dragonfly99]

I'm wondering how someone got to PGY 6 of a 7 year surgical residency and then got canned...shouldn't they have decided earlier than that that the person couldn't operatre?

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[Apollyon]

I'm wondering how someone got to PGY 6 of a 7 year surgical residency and then got canned...shouldn't they have decided earlier than that that the person couldn't operatre?

It was leadership issues, and some technical stuff. Guy could take orders like a champ, but not get it done when he was in the captain's chair.

 

[dragonfly99]

Interesting...but one would think someone could LEARN how to be in charge. I personally found being "under" people is harder...b/c you gotta anticipate what they want, etc. and try to please them instead of just deciding what is the right/best thing to do and doing it.

 

[Winged Scapula]

Bro, you're livin' in la-la-land.

Unlikely and I'm not sure where you would get that idea from. I am well aware that programs terminate residents, having trained at one that did it fairly frequently. Clearly you know nothing about me.

Having a list of hospitals that terminate more than one resident in twenty is very helpful, consider the statistics I posted above.

Note that NO WHERE above did marsupial (to whom I was responding) state that the hospitals listed terminate more than 1 in 20 residents on a regular basis.

If that is indeed true, then the information may be helpful. But the original post made it sound like he/she was simply listing hospitals that have terminated a resident in the past.

Let me tear into this again. There are programs, such as the one where I was terminated, where nearly every year since 2005, 33% of the residents gets the axe. It's true, for example, that many places don't have this problem, but if you end up in one of these gutter-ball residencies, you'll be pooping in your pants. I knew one resident in my program, she said, "well, so long as such-and-such is here, I don't have to worry about getting kicked out. But once he's gone, well, I know I'm next."

What do you think living like that is like?

That's quite a chip you have on your shoulder; you're making a comment from me about how a list of random programs without information about the reason residents are terminated, how many and how often isn't very useful into a personal affront. My comment was not meant as such but rather as an appeal for more information, and I have NO IDEA how you have found this to be directed at you.

We all know there are programs out there that have a pattern of terminating lots of residents. But how does it help me to see the list you have posted, without knowing WHAT specialties residents are routinely terminated from, at what level, for what offenses, how often, etc? And yes, being in a program like that must suck.

My former residency program terminated more than 1 resident for lying. Does that mean that everyone should avoid that program? Not necessarily, IMHO. All I wanted from marsupial was more information, which you have tried to make into something personal.

 

[Winged Scapula]

I'm wondering how someone got to PGY 6 of a 7 year surgical residency and then got canned...shouldn't they have decided earlier than that that the person couldn't operatre?

As Apollyon notes, its not always operative skill that gets people terminated. AAMOF, I have never seen someone terminated for lack of surgical skills but rather lying, inability to translate clinical knowledge into clinical practice, fund of knowledge deficits, inability to work well with others, unsafe practices, etc.

Programs don't like to terminate residents in the latter part of their training but they will if they feel that graduating this resident would mean producing an unsafe surgeon.

 

[Winged Scapula]

I know of one guy canned at Duke, and he got 3 tries at PGY-6 - three complete times. If that's not extending a helping hand, nothing is.

I don't know if all research surgery programs are the same way, but Duke is 2-2-3, clinical/research/clinical.

That is the typical structure.

Add on a fellowship and it became the "decade with Dave".

 

[DarthNeurology]

It was leadership issues, and some technical stuff. Guy could take orders like a champ, but not get it done when he was in the captain's chair.

It is really interesting how much responsibility chief surgical residents have in terms pf supervising the junior residents and sometimes medical students. It does appear to be different set of skills than being a junior resident, but not impossible to learn by any means, and at any rate different chief surgical residents have different styles. There is a lot of staring down and posturing in surgery, more than in IM IMHO, so I think it is easy to say that someone shouldn't be in the Captain's chair if they aren't as authoritative as the past chief resident. Still, wow, three years as chief surgical resident and didn't make it. Weird.

However, I don't think that the skills as a chief surgical resident are the same as the skills that an attending surgeon must have. For one, I think attending surgeons get more respect, and delegate the work much differently. A general surgeon could have an academic practice and do routine surgeries on a much more limited basis than a chief surgical resident. Also, attendings generally don't get yelled at as much as chief surgical residents . . . it must have been tiring to be the chief for so long and humiliating not to be allowed to graduate residency. I am sure that played a factor as no doubt there was a first impression that was impossible to change over his/her final three years.

 

[Winged Scapula]

Just a clarification Darth: PGY 6 is not the Chief year in academic general surgery. The resident Appollyon refers to was not a Chief.
It sounds as if you had a bad surgical clerkship which has colored your experience. Please understand that yelling is not a mandatory element of surgical training and that surgical leadership is not a measure of this.

 

[dragonfly99]

I have to say I was treated pretty crappy on my general surg clerkship as a 3rd year...and the house staff and a lot of the attendings seemed to be unhappy and had a terrible attitude, for the most part. I've never been yelled at, and, well...abused like that before or since There's pretty much no other way to say it. It seemed to be department dependent, though, because ENT and ortho were much nicer and seemed 1000% happier. Is there a reason why this particular attitude seems more prevalent among general surgeons, or was that perhaps just an anomaly of where I trained? Perhaps it is, because I've heard other trainees complain of how malignant neurosurgeons are, but I didn't think that ours were...

 

[DarthNeurology]

Just a clarification Darth: PGY 6 is not the Chief year in academic general surgery. The resident Appollyon refers to was not a Chief.
It sounds as if you had a bad surgical clerkship which has colored your experience. Please understand that yelling is not a mandatory element of surgical training and that surgical leadership is not a measure of this.

1. Sorry I didn't read the post correctly as I guess PGY-7 is the chief year in the Duke program, other residency programs may call their PGY-5 the chief year, so I am mistaken. I guess it is different for "academic general surgery programs." It seems like the resident couldn't fit in the "Captain's Chair", which seemed to me to mean that he wasn't a good chief, but I guess it means he wasn't a good senior surgery resident.

I have seen PGY-4s on the verge of becoming the chief resident and other residents/attendings didn't want them to do it, i.e. not ready for the responsibility, and made them repeat PGY-4

2. I didn't really have a bad surgery clerkship experience, mine was much better than most of the students and felt I got way much more respect from the chief surgery residents and attendings. Sure maybe I was yelled at a couple of times, but it was in the spirit of the program and everybody got the same. I didn't flinch, and held my ground and my superiors realized how competent I was and good surgical knowledge etc . . .

3. I have seen surgical attendings berrate chief surgical residents and junior surgical residents in a variety of settings. My experience with surgery was that it is like being in the army in that chief surgical residents and attendings are very "mean" at surbordinates and yes, have seen surbordinates being yelled at for *everything* from post-op care, to OR work, to workup of patients. It is not a pleasant process, and since I have done multiple surgery electives I have seen this at actually many different hospitals. While I survived the surgery clerkship with good evals, I viewed surgery as being a "hellish" residency in some places as chief residents *really* know how to make a junior surgery resident feel like pooh.

4. From my viewpoint, the chief surgery residents were under enough pressure in terms of being responsible for post-op patients, etc . . . that "yelling" did occur, and certainly verbally berrating residents and students was felt that it was needed for patient care by the chief residents. I have seen multiple times chief surgery residents sit down a group of subordinate surgery residents and medical students and everybody gets a good 20 minute talk about how our work is "b.s." and "you guys make us look bad, its like your not even thinking. Come on this is b.s. Residents x and y are staying with me an extra 12 hours, I don't care if you are post-call, you are going to go and fix all the charts and we will meet here in five hours." I always thought this was par for the course in the surgery world.

 

[doc4life95]

I have to say I was treated pretty crappy on my general surg clerkship as a 3rd year...and the house staff and a lot of the attendings seemed to be unhappy and had a terrible attitude, for the most part. I've never been yelled at, and, well...abused like that before or since There's pretty much no other way to say it. It seemed to be department dependent, though, because ENT and ortho were much nicer and seemed 1000% happier. Is there a reason why this particular attitude seems more prevalent among general surgeons, or was that perhaps just an anomaly of where I trained? Perhaps it is, because I've heard other trainees complain of how malignant neurosurgeons are, but I didn't think that ours were...

Where did you do this clerkship?

 

[dacrocytic]

My situation was a little different, but there are some important issues that need to be emphasized. I suddenly found myself in my 4th yr of residency being the target of a PD who never could present to me any specific "charges" against me. The PD could only present some nebulous "perceptions" from an immature new attending (who had only been a resident a few months earlier) about my "lack of confidence" in making clinical decisions. I had volunteered to do an extra 6 months of clinical rotations, so since I had started residency on an off-cycle anyway, I would still graduate at the same time as my resident colleagues.

I then discovered that the PD was trying to change the conditions we had agreed upon -- making my additional 6 months contingent on passing an oral exam that no one else had to complete. The PD was actually trying to kick me out with 6 months left to go in the residency training! I initially left the PD's office very disoriented, feeling "as if I should step in front of a moving truck" to end my misery.

But fortunately I talked with a "resident-friendly" attending supervisor who gave me specific instructions about how to proceed. And I was told that the PD could not base termination on only a very small part of the training that was only based on the PD's perceptions. In other words, the majority of good evaluations trumped the PD's opinion.

The residents facing the prospect of termination should be aware that some PDs try to intimidate the residents so that they will resign on their own. Therefore, they should make certain that all meetings with the PD are documented in writing (preferably with another attending as a witness) and not sign off on anything to which they do not agree.

It would probably be beneficial for the residents to obtain the services of an attorney to assure that due process is followed here. Sometimes when a resident shows up with an attorney, it causes the PD and the department to re-think their proposed plan to terminate the resident. Funny how the fear of litigation can balance the power game taking place?

Hi DR Mona
I do hope everything turned out okay for you
this sounds very harrowing and would have me feeling lost as well
-sometimes we gotta stand up for ourselves (especially women)

 

[TTPHUS]

Interesting...but one would think someone could LEARN how to be in charge. I personally found being "under" people is harder...b/c you gotta anticipate what they want, etc. and try to please them instead of just deciding what is the right/best thing to do and doing it.

very true

 

[dr0277341283141]

Unlikely and I'm not sure where you would get that idea from. I am well aware that programs terminate residents, having trained at one that did it fairly frequently. Clearly you know nothing about me.

Listen, honeybuns, you just seemed really defensive... you are, after all, an attending...

 

[Winged Scapula]

Listen, honeybuns, you just seemed really defensive... you are, after all, an attending...

Nope not defensive at all just responding to some gross inaccuracies and assumptions in your post.

But if you go around addressing female attendings as "honeybuns" perhaps I now understand why you have had some trouble in residency.

 

[teri78]

Listen, honeybuns, you just seemed really defensive... you are, after all, an attending...

WOW! No wonder you were terminated.

 

[dragonfly99]

WOW! No wonder you were terminated.

I agree with this, if this is how he talks to attendings....not a good plan.

 

[thinkingman]

I feel that **** (personal information deleted) (winged scapula) is being very mean when she says that dr0277341283141 was right to be terminated. I find it arrogant on her part to assume that residents facing problems are the "problems" themselves.

I don't want to justify either of them, but I think dr0277341283141 called her "honeybuns" because she was repeatedly being defensive and mocking dr0277341283141 and residents who have trouble. I hope ***** understands that she is not immune to unfair treatment/ harassment.

I don't wish it, but **** (winged scapula) and people like her would understand a terminated resident's pain when they are unfairly sued, made to pay up all their money in court, and then permanently disqualified from medical practice.

Nope not defensive at all just responding to some gross inaccuracies and assumptions in your post.

But if you go around addressing female attendings as "honeybuns" perhaps I now understand why you have had some trouble in residency.

Originally Posted by dr0277341283141
Listen, honeybuns, you just seemed really defensive... you are, after all, an attending...

 

[nsap102]

I feel that ***** (winged scapula) is being very mean when she says that dr0277341283141 was right to be terminated. I find it arrogant on her part to assume that residents facing problems are the "problems" themselves.

I don't want to justify either of them, but I think dr0277341283141 called her "honeybuns" because she was repeatedly being defensive and mocking dr0277341283141 and residents who have trouble. I hope **** understands that she is not immune to unfair treatment/ harassment.

I don't wish it, but **** (winged scapula) and people like her would understand a terminated resident's pain when they are unfairly sued, made to pay up all their money in court, and then permanently disqualified from medical practice.

Hallelujah!

One thing that I've learned from my experience is that everyone wants to kick, beat and bite you when you're down!

I want to bite back.

 

[slight365]

I feel that **** (winged scapula) is being very mean when she says that dr0277341283141 was right to be terminated. I find it arrogant on her part to assume that residents facing problems are the "problems" themselves.

I don't want to justify either of them, but I think dr0277341283141 called her "honeybuns" because she was repeatedly being defensive and mocking dr0277341283141 and residents who have trouble. I hope **** understands that she is not immune to unfair treatment/ harassment.

I don't wish it, but **** (winged scapula) and people like her would understand a terminated resident's pain when they are unfairly sued, made to pay up all their money in court, and then permanently disqualified from medical practice.

You got the spelling wrong.

 

[dragonfly99]

Regardless of what Winged Scapula's comment(s) were, calling her "honey buns" was grossly inappropriate. Yes, WS does at times have a sharp tongue and I have disagreed with her on occasion, but I think that derogatory and misogynistic comment was grossly inappropriate by any standard of professionalism, and not just because WS is an attending. It would be inappropriate to call any female student/resident/attending/work colleague "honey buns". It's ridiculous and so totally inappropriate. Of course, such things are to be expected on an anonymous message board...

 

[slight365]

I can't believe we're so sensitive now that "honey buns" becomes "grossly inappropriate". On an internet forum, no less.

I submit that the comment is so ridiculous and so antiquated that it can't possibly be inappropriate at this time.

 

[Winged Scapula]

I feel that **** (personal information deleted) (winged scapula) is being very mean when she says that dr0277341283141 was right to be terminated. I find it arrogant on her part to assume that residents facing problems are the "problems" themselves.

I have never assumed any such thing.

But the fact of the matter is that, IMHO, both in residency and practice and here on SDN for over 10 years is that the vast majority of the time residents are terminated for good reasons. This has been stated by several other attending and program director members of SDN as well; I am not alone in that observation.

That doesn't mean that I don't recognize that some become scapegoats and the faculty look for violations to terminate the resident; "violations" which would be ignored for well liked residents. I've said that multiple times here.

As far as being mean, it was not my intention, but many residents who are terminated fail to see where their mistakes are or to try and rectify them. I don't have all the answers and plenty of people disagree with me. But there are also many others than share my thoughts and experiences, which is what an internet BB is about.

I don't want to justify either of them, but I think dr0277341283141 called her "honeybuns" because she was repeatedly being defensive and mocking dr0277341283141 and residents who have trouble. I hope ***** understands that she is not immune to unfair treatment/ harassment.

Please show me where I was repeatedly being "defensive" and mocking the user. I have no reason to be defensive. I'm not a residency program director nor have any investment in this conversation other than to point out that we've heard this story a thousand times and almost always some information comes to light that shows that the resident may not have been terminated without warrant.

I don't wish it, but **** (winged scapula) and people like her would understand a terminated resident's pain when they are unfairly sued, made to pay up all their money in court, and then permanently disqualified from medical practice.

I do understand and am sympathetic to those problems. Medicine and medical education are flawed in that there is little recourse for someone in that situation. However, I do not believe we were talking about a resident being "sued" in this thread.

I can't believe we're so sensitive now that "honey buns" becomes "grossly inappropriate". On an internet forum, no less.

I submit that the comment is so ridiculous and so antiquated that it can't possibly be inappropriate at this time.

One would think, but it is fairly clear to me and others, that the term is used, in this context, and others, to derogate women. This is, IMHO, common amongst men who don't want to seem outrightly misogynistic so they become passive aggressive and use terms like "honeybuns" and "sweetie". Frankly, it is no less offensive than calling someone a bitch because that is generally its meaning.

It IS grossly inappropriate in the professional workplace but I don't make that big of a deal about it on a internet forum other than to note that its use tells me a lot about the user.

 

[dragonfly99]

I can't believe we're so sensitive now that "honey buns" becomes "grossly inappropriate". On an internet forum, no less.

I submit that the comment is so ridiculous and so antiquated that it can't possibly be inappropriate at this time.

Of course it IS ridiculous and antiquated. I agree with you about that. Why can it not possibly be inappropriate? Of course it is inappropriate....he wasn't talking to his girlfriend...sweetie

 

[Rogue Synapse]

WS - I'm with you about the passive-aggressive "honeybuns", "sweetie", etc. Unless you're in the South and virtually every female gets called "honey" or "sweetie" (a fact which, in turn, may be revealing about sexual attitudes down here). Still, honeyBUNS seems like it definitely has some sort of sexually charged connotation.

 

[michaelrack]

WS - I'm with you about the passive-aggressive "honeybuns", "sweetie", etc. Unless you're in the South and virtually every female gets called "honey" or "sweetie" (a fact which, in turn, may be revealing about sexual attitudes down here). Still, honeyBUNS seems like it definitely has some sort of sexually charged connotation.

I like the sexual attitudes down here in the South (Mississippi).

 

[peerie]

Well, I think we have all lost the focus of the thread and this has degenerated into a verbal fist fight. Never a good thing. Feelings are runnng high!

Can we come back to the original topic. I have had some thoughts.

I would definitely agree that it happens that you get on the wrong side of the wrong person and then you are out in the rain and you don't even know what happened. Or who you upset or anything. That is a terrible situation to be in and it definitely happens. How to avoid it? Medicine is a unique environment with severe constraints and delicate egos. Dragonfly's advice and others, has been excellent. Do your very best to be quiet, friendly and never offend anyone. Ever. Apologize if you make a mistake, be friends with everyone and just roll with the waves. Be agreeable.

On the other hand, I have seen some people that have made me concerned about patient welfare and - well, I can understand why people are let go for incompetence. In the end, it comes down to each person and are we able to grow and change? learn to fit in, do whatever it takes to make it work? Residency is a unique situation, and we are lucky if we are deeply changed by the process as we learn clinically, socially and most definitely emotionally.

 

[thinkingman]

The question that I ask is : Who gets to decide whether a resident is competent or not ? What is the degree of competence which can differentiate a competent resident from an incompetent one?

We don't require every MD student to be perfect for him/her to graduate, then how do we expect every intern/ resident to be exemplary right away ? Do we really want an intern to permanently give up his medical career just because the residency program did not think he was good enough during his internship year? Gosh! Whatever happened to remediation, and training ?

Looks like many in our system (faculty, attendings) have forgot that residency is supposed to be training and not just evaluation. Many residents, and attendings have become used to abusing and getting abused - we need some sort of reform here folks !

Again, nothing personal against winged scapula, I just felt that she should have been more sensitive at her level (attending, senior SDN admin etc)

 

[slight365]

Not that I'm inside the argument, but the edit of "personal information" to remove Winged Scapula's name is pretty pathetic. She doesn't realize that she's got public profiles of herself, even on this site. That makes her a Public Figure.

Can't handle it? Don't go for internet fame.

 

[Winged Scapula]

Not that I'm inside the argument, but the edit of "personal information" to remove Winged Scapula's name is pretty pathetic. She doesn't realize that she's got public profiles of herself, even on this site. That makes her a Public Figure.

Can't handle it? Don't go for internet fame.

I obviously realize that my name is out there. Call it pathetic if you wish, but protecting the rights and privacy of our users and staff members is a priority at SDN. I deserve no less than any other member here.

What I find pathetic is a "new" user registering seemingly with the intent to complain about me and "out" me, while registering with a proxy address to conceal his SDN identity.

The posting of personal information is a violation of the SDN Terms of Service and I try to limit any such information where possible. The TOS is very clear on this.

Using your definition, pretty much anyone is a public figure, as I'd wager almost everyone has some internet profile - whether its a listing of college graduates, residency members, participating in a HS track meet, etc. These are all documented and can be found on a search. However, that doesn't mean that posting my name along with my user name is appropriate. I have access to a lot of user's names IRL...but it would be wrong for me to post them, no? This was the reason I changed my user name several years ago and it has limited the amount of Google "hits" I get.

Clearly people can find out who I am, but you'd be suprised at the number of users who have no idea who I am or how to find out that information. Not everyone is as sophisticated as you.

 

[mcl]

The question that I ask is : Who gets to decide whether a resident is competent or not ? What is the degree of competence which can differentiate a competent resident from an incompetent one?

We don't require every MD student to be perfect for him/her to graduate, then how do we expect every intern/ resident to be exemplary right away ? Do we really want an intern to permanently give up his medical career just because the residency program did not think he was good enough during his internship year? Gosh! Whatever happened to remediation, and training ?

The ACGME has taken a lot of pains to introduce the concept of competency and make it a (if not the) central component of resident evaluation. For each rotation at each level, we have to have defined expectations based on the six core competencies, and at least two methods of evaluating each. At this point, we are also supposed to be contacting post-residency employers to get their assessments of our residents' competency when they are in practice.

Residents aren't expected to be perfect, and there is a huge learning curve the first year--but they are expected to be open to critique and to learn from both positive and negative experiences. If they don't meet the department's defined competency standards for their level of training, remediation certainly comes into play before termination.

Anyone interested in learning more about the core competencies can go to the ACGME web site and read about the Outcomes Project.

 

[slight365]

I obviously realize that my name is out there. Call it pathetic if you wish, but protecting the rights and privacy of our users and staff members is a priority at SDN. I deserve no less than any other member here.

The posting of personal information is a violation of the SDN Terms of Service and I try to limit any such information where possible. The TOS is very clear on this. Your profile is up there to help people and get your name out there, no? Once it's out there on the web, it's impossible to bring it back.

Using your definition, pretty much anyone is a public figure, as I'd wager almost everyone has some internet profile - whether its a listing of college graduates, residency members, participating in a HS track meet, etc. These are all documented and can be found on a search. However, that doesn't mean that posting my name along with my user name is appropriate. I have access to a lot of user's names IRL...but it would be wrong for me to post them, no? This was the reason I changed my user name several years ago and it has limited the amount of Google "hits" I get.

Clearly people can find out who I am, but you'd be suprised at the number of users who have no idea who I am or how to find out that information.

Actually, there are clearly defined standards for public profiles and information that will go beyond TOS. Anything contained in public profiles you willingly agreed to put up is there for those to address you by, which is what was done.

As far as your access to user's real names, IRL, use of such is actually a gross violation of the internet policies set forth not only by the provider the server is on, but is also criminally prosecutable.

I have and continue to work in web development, and this is a reality. One of the most overlooked things on internet forums is that "moderator" or "administrative" controls are given to users, but there is almost never an agreement made, nor even a mention about how TOS applies to users as well and what is even the responsibility of IP searches, only when necessary, not when bored.

Is anyone here to believe you've never run an IP search out of curiosity? Guess what? That's a violation of privacy rights that aren't given up in the TOS one checks off on when they sign up to the forum. That info is only to be used for specific reasons. It would be wrong for you to post their info because they have not made them public and you accessing them through IP's or email addresses used for registration is actually stalking. I interpret your mention of how you have access to people's identities as veiled intent that you're basically saying you can get back at anyone who tries to mess with you on the forum, otherwise you would not have brought it up and threw it in the faces of the users.

I'm only bringing this up because there's now an ethical and legal issue the site is now treading.

 

[yaah]

There are all types of ways SDN users find out real identities - often through PMs, often through someone posting their own information at one or more times, and sometimes through disturbing detective work and stalking. It is inappropriate to suggest that just because someone's name has been out there and linked to their account at some time in the past that it means bringing that up whenever we want is ok. Users (including admins!) have the right to not have their name out there. Whether it can be discovered through internet detective work is not the point.

Nowhere in WS's post did she suggest she was looking up peoples' information through IP searches out of curiosity. She is probably similar to me, in that she knows many users' identities through simply being here for years. From my perspective, I have had users randomly approach me at national meetings, interviews, etc (I don't know how they figured out who I was, I think it's actually disturbing that they do know it without me telling them) and tell me who they were on the site. I have also had people tell me who they were via PM. Others make it obvious because they post enough information that you can figure it out. But because I know that user X is actually resident X at Hospital Y, I don't go then posting it all over the site.

Therefore, you are making a leap that is not really justified.

It is not really the ethical and legal issue you are making it out to be. It would be if mods/admins were using nefarious means to identify users (which we would be removed from the site for doing - we actually do sign a statement stating it is not permitted). But that is not the issue. The issue is that every user has the right to limit how much of their own information is put out there. It becomes harder to control when it has been willingly out there in the past, but that doesn't mean you don't try.

 

[Winged Scapula]

As far as your access to user's real names, IRL, use of such is actually a gross violation of the internet policies set forth not only by the provider the server is on, but is also criminally prosecutable.

I wasn't referring to my access as an SDN staff member, but simply knowing user's real names, etc. from conversations had here, FB entries, etc. THAT is not prosecutable. I've had plenty of users approach me at conferences, residency interviews, board review courses, etc. and introduce themselves, so a lot of us know who each other are IRL, but I would not dream of exposing them.

It can be fairly easy to figure out who people are, but that doesn't make it right to make an effort to make it easier for others.

I have and continue to work in web development, and this is a reality. One of the most overlooked things on internet forums is that "moderator" or "administrative" controls are given to users, but there is almost never an agreement made, nor even a mention about how TOS applies to users as well and what is even the responsibility of IP searches, only when necessary, not when bored.

Is anyone here to believe you've never run an IP search out of curiosity? Guess what? That's a violation of privacy rights that aren't given up in the TOS one checks off on when they sign up to the forum. That info is only to be used for specific reasons. It would be wrong for you to post their info because they have not made them public and you accessing them through IP's or email addresses used for registration is actually stalking.

All SDN staff members have to sign a non-disclosure statement and are severely chastized or even removed from staff for such behavior. IP searches are run when there is sufficient evidence to warrant suspicion that the user is a repeat troll or a proxy, such as for the user above.

I interpret your mention of how you have access to people's identities as veiled intent that you're basically saying you can get back at anyone who tries to mess with you on the forum, otherwise you would not have brought it up and threw it in the faces of the users.

Nope, no such threats. My comment was simply meant to reflect that as an SDN MEMBER (not staff), a lot of us have access to other's information. Every user who posts that information is subject to administrative action, regardless of how easy the person has made it to figure out who they are. Thus, my situation is no different than someone in the Lounge who knows another user, referring to them by name (which happens a lot). If the user complains, action is taken.

 

[slight365]

I wasn't referring to my access as an SDN staff member, but simply knowing user's real names, etc. from conversations had here, FB entries, etc. THAT is not prosecutable.

It can be fairly easy to figure out who people are, but that doesn't make it right to make an effort to make it easier for others.



All SDN staff members have to sign a non-disclosure statement and are severely chastized or even removed from staff for such behavior. IP searches are run when there is sufficient evidence to warrant suspicion that the user is a repeat troll or a proxy, such as for the user above.




Nope, no such threats. My comment was simply meant to reflect that as an SDN MEMBER (not staff), a lot of us have access to other's information. Every user who posts that information is subject to administrative action, regardless of how easy the person has made it to figure out who they are. Thus, my situation is no different than someone in the Lounge who knows another user, referring to them by name (which happens a lot). If the user complains, action is taken.

So even with the non-disclosure, is it still an area where one has to judge for themselves and use their own discretion before running an ip search, or do they have to contact a site admin before running an ip search?

 

[slight365]

There are all types of ways SDN users find out real identities - often through PMs, often through someone posting their own information at one or more times, and sometimes through disturbing detective work and stalking. It is inappropriate to suggest that just because someone's name has been out there and linked to their account at some time in the past that it means bringing that up whenever we want is ok. Users (including admins!) have the right to not have their name out there. Whether it can be discovered through internet detective work is not the point.

Nowhere in WS's post did she suggest she was looking up peoples' information through IP searches out of curiosity. She is probably similar to me, in that she knows many users' identities through simply being here for years. From my perspective, I have had users randomly approach me at national meetings, interviews, etc (I don't know how they figured out who I was, I think it's actually disturbing that they do know it without me telling them) and tell me who they were on the site. I have also had people tell me who they were via PM. Others make it obvious because they post enough information that you can figure it out. But because I know that user X is actually resident X at Hospital Y, I don't go then posting it all over the site.

Therefore, you are making a leap that is not really justified.

It is not really the ethical and legal issue you are making it out to be. It would be if mods/admins were using nefarious means to identify users (which we would be removed from the site for doing - we actually do sign a statement stating it is not permitted). But that is not the issue. The issue is that every user has the right to limit how much of their own information is put out there. It becomes harder to control when it has been willingly out there in the past, but that doesn't mean you don't try.

Fair enough, but it shouldn't also be a surprise when the public information is brought up on the site. If she doesn't want to be surprised when someone mentions something from a public profile, the reasonable response would be to remove the public profile, as it's the source of the distress and conflict, not the fact that someone fairly benignly used some info there to address her by her real name on a forum connected with the profile.

That's the part that makes this ridiculous, and I understand you will defend a staffer to death, but there's also a point where the staffer shouldn't make the fact that they can't handle the effects of their own public profile.

Bottom line- if they can't handle that people read the profile and know about the person from what they've said, then the profile should not be up, or the person should step down or not get involved in a position, such as a forum staffer, where their decisions polarize groups of people, whether right or wrong, and can result in such mild use of their public profile causing massive distress, while polarizing users against the site, thus making your jobs harder.

 

[Winged Scapula]

Fair enough, but it shouldn't also be a surprise when the public information is brought up on the site. If she doesn't want to be surprised when someone mentions something from a public profile, the reasonable response would be to remove the public profile, as it's the source of the distress and conflict, not the fact that someone fairly benignly used some info there to address her by her real name on a forum connected with the profile.

That's the part that makes this ridiculous, and I understand you will defend a staffer to death, but there's also a point where the staffer shouldn't make the fact that they can't handle the effects of their own public profile.

Bottom line- if they can't handle that people read the profile and know about the person from what they've said, then the profile should not be up, or the person should step down or not get involved in a position, such as a forum staffer, where their decisions polarize groups of people, whether right or wrong, and can result in such mild use of their public profile causing massive distress, while polarizing users against the site, thus making your jobs harder.

You are missing the point.

Its not only the issue that my real name was used. This has happened frequently in the past, most often by friends IRL and others who "benignly" and innocently are careless.

The problem here, and you should recognize this as you are familiar with the workings of the internet, is that a "new" user registered with a proxy address, came to an old, contentious thread and his first post is to deride me and post my real name.

Innocent users do not do this. These are the actions of an internet troll. An innocent benign user does not register with a proxy and does not make his first post an attack against another user in an old thread. These are the actions of someone who is known here and wants to keep his identity a secret.

THAT is the crux of the problem. If you are going to have the cojones to try and reveal my real name in an effort to somehow discredit or disparage me, at least have the courtesy to use the SDN name you've used all along. There are enough staff members and other users who recognized that this was not the work of some new "benign" members.

I am not worried about SDN users knowing my real name. I wish to lessen the ability of patients who are internet savvy to find posts here which are not relevant to their care. Clearly I could remove all identifying characteristics, pictures, etc. from SDN. However, I have always been proud of the fact that I am open about who I am, where I am and what I do. Users who want to know my real name only need ask; it does not need to be posted in the open forums. The use of the TOS protects me even if choose to display a lot of personal information about myself.

 

[slight365]

You are missing the point.

Its not only the issue that my real name was used. This has happened frequently in the past, most often by friends IRL and others who "benignly" and innocently are careless.

The problem here, and you should recognize this as you are familiar with the workings of the internet, is that a "new" user registered with a proxy address, came to an old, contentious thread and his first post is to deride me and post my real name.

Innocent users do not do this. These are the actions of an internet troll. An innocent benign user does not register with a proxy and does not make his first post an attack against another user in an old thread. These are the actions of someone who is known here and wants to keep his identity a secret.

THAT is the crux of the problem. If you are going to have the cojones to try and reveal my real name in an effort to somehow discredit or disparage me, at least have the courtesy to use the SDN name you've used all along. There are enough staff members and other users who recognized that this was not the work of some new "benign" members.

I am not worried about SDN users knowing my real name. I wish to lessen the ability of patients who are internet savvy to find posts here which are not relevant to their care.

I actually searched, and the #1 return in a google search was a thread here, with your name as the title, and the users addressing you by your first name off the bat.

Perhaps there's a troll in that, but also I've seen some especially odd looking responses here as well, in terms of conduct and standards.

Now that we know about this contract you have to "sign" before you're a staffer, can you make that available? Actually, in terms of the issues of privacy, such a document MUST be made available, so the users are aware of the TOS the staff has to conform to in order to protect the personal information they are privy to for users through private IP's and other registration and usage info and how the information will be used.

This would also show conformity to the TOS of the server's hosting agency to either comply with their privacy and conduct codes, or absolve them of issues created by misconduct on this forum by staff should there ever have to be questions they would have to answer (and behind the scenes, it does happen more than people know) from investigators.

 

[Rendar5]

This is the weirdest change of topic i've ever seen on a thread here...seriously, what's the point of causing a dramatic shift in topic to just to intellectually masturbate about internet privacy rules on sdn.

 

[tkim]

Now that we know about this contract you have to "sign" before you're a staffer, can you make that available? Actually, in terms of the issues of privacy, such a document MUST be made available, so the users are aware of the TOS the staff has to conform to in order to protect the personal information they are privy to for users through private IP's and other registration and usage info and how the information will be used.

I've never heard of such a requirement. Where does this requirement come from?

 

[slight365]

Have you ever dealt with websites and hosting?

Do you know what requirements are required for collection of personal data and usage of such data? This lies mostly on the hosting end, and often times, site administrators are unaware, or casually overlook such issues. The fact that they have a privacy agreement they say the sign to get a spot on staff speaks volumes of their knowledge of such things.

As with any issues arising from privacy and personal data collection, the information must be made available upon request, and this is one way law enforcement is also able to obtain data and profiles of users of sites from hosting companies in the course of an investigation without consent of the site, for instance. That should actually be one of the points addressed in such usage agreements. Often times, not. They tend to be contained in usage agreements with hosts, and affect all users of a site, which doesn't necessarily get relayed when one checks off the box that they are agreeing to the site TOS.

And really, there are rules on the internet. It's naive to think there are no laws that govern the internet, whether civil or criminal recourse to enforce it is a matter for the individual cases.

 

[tkim]

Have you ever dealt with websites and hosting?

Do you know what requirements are required for collection of personal data and usage of such data? This lies mostly on the hosting end, and often times, site administrators are unaware, or casually overlook such issues. The fact that they have a privacy agreement they say the sign to get a spot on staff speaks volumes of their knowledge of such things.

As with any issues arising from privacy and personal data collection, the information must be made available upon request, and this is one way law enforcement is also able to obtain data and profiles of users of sites from hosting companies in the course of an investigation without consent of the site, for instance. That should actually be one of the points addressed in such usage agreements. Often times, not. They tend to be contained in usage agreements with hosts, and affect all users of a site, which doesn't necessarily get relayed when one checks off the box that they are agreeing to the site TOS.

And really, there are rules on the internet. It's naive to think there are no laws that govern the internet, whether civil or criminal recourse to enforce it is a matter for the individual cases.

Uh, okay. So, where is this requirement again?

 

[slight365]

You can inquire actually through the hosting agent of this site, or any of the service providers that allow site hosting.

By your convention, there would be no need for a contract to be signed by staff her, nor will there be a reason for them to dish out disciplinary measures, or attempt to regulate such things as ip searches, which are not controllable. Those with that ability can use them at will.

 

[tkim]

You can inquire actually through the hosting agent of this site, or any of the service providers that allow site hosting.

By your convention, there would be no need for a contract to be signed by staff her, nor will there be a reason for them to dish out disciplinary measures, or attempt to regulate such things as ip searches, which are not controllable. Those with that ability can use them at will.

Or, look at the bottom of every SDN page under 'privacy policy'. Little easier that way.

Uh, by what 'convention'?

 

[slight365]

What my interest is this contract that is supposedly part of the privacy agreement and carries "harsh" internal penalties for misuse, despite the inability to control usage. That was the interest in the beginning, despite your trying to move it elsewhere. And yes, the policy was read, but it doesn't indicate this contract that appears to be an integral part of it.

 

[tkim]

What my interest is this contract that is supposedly part of the privacy agreement and carries "harsh" internal penalties for misuse, despite the inability to control usage. That was the interest in the beginning, despite your trying to move it elsewhere. And yes, the policy was read, but it doesn't indicate this contract that appears to be an integral part of it.

What I'm trying to get is where this requirement of yours, i.e.:

Now that we know about this contract you have to "sign" before you're a staffer, can you make that available? Actually, in terms of the issues of privacy, such a document MUST be made available,

comes from. Is it a law? Some rule of the internet? Can you furnish some link to this requirement? Or is it because of your experience as a web developer that you know this? You know how information validation works, it's not as you say because you say it is so. Your focus is the contract staffers are required to agree upon. My focus is the supposed requirement that such contract be furnished upon request. Claro?

 

[dragonfly99]

The ACGME has taken a lot of pains to introduce the concept of competency and make it a (if not the) central component of resident evaluation. For each rotation at each level, we have to have defined expectations based on the six core competencies, and at least two methods of evaluating each. At this point, we are also supposed to be contacting post-residency employers to get their assessments of our residents' competency when they are in practice.

Residents aren't expected to be perfect, and there is a huge learning curve the first year--but they are expected to be open to critique and to learn from both positive and negative experiences. If they don't meet the department's defined competency standards for their level of training, remediation certainly comes into play before termination.

Anyone interested in learning more about the core competencies can go to the ACGME web site and read about the Outcomes Project.

Glad that someone went back to something relating to the original topic of this post. A lot of med students on here probably don't know anything about the six core competencies. I guess it is laudable that the ACGME is trying to create some sort of structure for resident evaluations. On the other hand, having read the six core competencies multiple times, and been asked to evaluation others on these six "categories" as a member of the house staff, I have to say that these competency criteria are sufficiently vague that they end up being mostly subjective. People end up just checking the little boxes, giving higher scores to people who seem smarter and nicer and/or get along with them better, and lower if they don't like the person or the person seems blatantly dense or incompetent. I'm not sure that trying to define six core competencies gets us any closer to making the best physicians/products coming out of residency.

In my opinion, a lot of what is learned during residency comes down to individual resident effort, the quality of the attendings who are doing the teaching, and the case mix coming into the hospital (i.e. are there enough patients to work up if you are doing IM, and enough good operations to participate in if you are training in general surg.?). Also, the overall quality of the hospital where one is training is important (i.e. is it one w/good support staff and not too much scut, vs. one that just bleed the house staff dry doing things that could be done by secretaries, patient transporters, phlebotomists, etc.).

 

[peerie]

In my opinion, a lot of what is learned during residency comes down to individual resident effort, the quality of the attendings who are doing the teaching ... Also, the overall quality of the hospital where one is training is important.

I would also agree with mcl about the feedback issue, being receptive to feedback from staff, attendings and senior (or other) residents. I think that can be huge and I know I struggled in the beginning of my clinical training to understand that the angry comments I was experiencing from some of the attendings on rounds were actually (perhaps) meant as constructive criticism.

Being older and I hope wiser, I would say that this is the key. Being able to hear what the feedback is and to then change. It's all about the learning, and like dragonfly said it comes down to the resident and his/her self-motivated learning. I work very hard to chase down information and learn as much as I can. I want to provide the very best care I can to my patients. But I have seen people who will not do this and don't want to do any more than they can get away with. In the end, patients will chose who they want to go to but I can see how programs struggle with the competency issue. Popularity is also certainly a part of the assessment, and I would agree with DF99's comments on this as well.

This is a really great discussion and I find the comments really helpful; can we all stay on this excellent topic and maybe not be bashing our esteemed colleagues on this forum?

 

[slight365]

What I'm trying to get is where this requirement of yours, i.e.:



comes from. Is it a law? Some rule of the internet? Can you furnish some link to this requirement? Or is it because of your experience as a web developer that you know this? You know how information validation works, it's not as you say because you say it is so. Your focus is the contract staffers are required to agree upon. My focus is the supposed requirement that such contract be furnished upon request. Claro?

Is this site not part of a non profit organization that takes donations? Normally, transparency is also a requirement to maintain the status. That is only one angle.

And why do you believe a contract stating the parameters for protection of our privacy is not something that could or should be furnished? I know you like the site and all, but a lot of people also like their privacy.

 

[slight365]

What I'm trying to get is where this requirement of yours, i.e.:



comes from. Is it a law? Some rule of the internet? Can you furnish some link to this requirement? Or is it because of your experience as a web developer that you know this? You know how information validation works, it's not as you say because you say it is so. Your focus is the contract staffers are required to agree upon. My focus is the supposed requirement that such contract be furnished upon request. Claro?

Is this site not part of a non profit organization that takes donations? Normally, transparency is also a requirement to maintain the status. That is only one angle.

And why do you believe a contract stating the parameters for protection of our privacy is not something that could or should be furnished? I know you like the site and all, but a lot of people also like their privacy. Again, I ahve said there are governing bodies and rules, why not look up the regulatory body? THey're regularly in the news, and why not get in touch with some hosting companies? I've already said that to you.

Furthermore, non-profit also creates another situation where transparency has to be maintained.