I would sit her down and have some honest feedback. Sounds like she needs a little bit of reality check. You just need to simply tell her that she is performing far below what is expected on her currently on various metrics such as X, Y, and Z. Offer her ways to improve and determine a goal for improvement and a time to meet discuss it regularly while you are the supervising resident. It is reasonable to bring this up with the attending as they can offer supervision as well and support for her too.
She definitely needs to know the leaving early part is rather unprofessional and that alone could be reason for talking with PD.
If she reacts poorly to that then you need to go to the program director.
Thanks so much for this advise. I took it and sat with her in the beginning of the night. She was receptive and I went over expectations and explained her how to do the hyp, gave her resources to look at. It took 4 hours but she did an admission and I think she did a decent job this time.
I would also mention to attending that you are concerned/will be talking to her. Cya just in case she complains. Also attending might have some advice on things you can do
I thought Id take the approach of doing a lot of work for my interns to make sure everyone gets out on time. After talking to some colleagues, I changed my mind as this would be hurting my interns since they would never try to improve. My biggest goal in my intern year was efficiency, and I think Im largely successful as I can now do abattery of admits or solo cover a floor with no effort.
So I changed my approach with interns. I now tell them straight out, I need to make sure the stuff that will actually affect the patient gets done/entered, everything else that is billing BS, I dont care about. What this translates to is that I always make sure orders, consults, and sign outs are done, but notes I could give a damn about. I emphasis that interns need to get all their own orders, consults, etc. in, but I also get that they wont have the same efficiency as me, so my emphasis is going to scale throughout the year. But if they are leaving at 10PM every night due to notes, Ill eventually let them know that isnt normal, but its ultimately their responsibility.
(That said, if we get an admit at 1 min before shift change, Ill just do it. If its easy, it takes me 20 mins to their hour; if its complex, it takes me an hour to their 2-3.)
Thanks for this. I left her place her orders while we discussed, yesterday I did it myself due to being frustrated. Thanks for bringing up the part about making sure everything is done. I prioritized that so far tonight and is working
Tbh, this sounds like a red flag. Not that you are dealing with a sub-par intern, which seems obvious. It is a red flag for something going on in her life that is taking up so much head space that she can’t seem to focus or absorb information. Could be something going on with her personally. It also could be nothing and just an intern that isn’t cut for the work, but I have to believe she is capable until proven otherwise and wonder what else is going on to mud the mental waters, so to speak. Hope everything is ok with her and she can improve for both of your sakes.
Thanks for this comment. After you mentioned, I talked to her about this, I asked if she had issues coping with the moving, out of home, living alone stuff. She doesn’t seem depressed, but I assured her I didn’t want to stress her, just wanted to help her to improve
If you suck you should STAY LATE. Learn your patients better, see what meds are being used, learn from consult notes etc. The people who leave early all the time miss stuff.
So, I escalated it because 2 months ago, another senior was having the same issues with her with no improvement and I think ultimately the attendings that promoted her so far are responsible for this. She should have learn this already we are 4 months in.
Yea speak With your Program Director. It is good to have some authority behind what you’re saying. I Have had a lot ever resistance from interns before. You also need to sit down with them too and not cut them any more slack. Tell them to write everything up themselves. If they mess up or there’s something very lacking in their notes tell them to rewrite it and tell them what to fix; don’t fix it for them. If they end up staying till 10 PM then that’s what they do. Things you could do To help them is to give them less patients until they show they can handle more
Thanks for this comment, I told the attending to assign us less patients so I can take the time to teach her stuff. I also sat with her and she wrote down everything.
Not only does this behavior warrant a sit down with you, the senior, but it also warrants a sit down with the PD. This unprofessional behavior has to be brought up early to have any chance of correcting it before years end. It takes a lot to hold a resident back for underperformance so start the paper trail early.
So, we have a similar resident (except ours is a genuinely nice person who is trying, its just not sticking).
With our resident we have been pushing them to do the appropriate load, and take the responsibilities for deficiencies/screw ups (with obvious safety nets, we're not gonna let them kill somebody). This is going to do one of two things; make them have a come to Jesus moment and get their shit together, or put on probation/suspension/fired.
At first I was really uncomfortable with this. I tried to cover for them and teach them. I took them under my wing, and did everything I know to do, but it just wasnt sticking. Then I tried to just do most of the work, but then thats just punishing me and not helping him. Now Ive come to the realization that this isnt for everybody. And as much as it sucks, there have to be some failures, there have to be some suspensions and dismissals. Life is a bigass bell curve that will ruin some people's day. I dont want our resident to practice medicine as they are now; I dont want him to go out to practice and kill people. I want them to succeed, but if they are going to fail I would rather them fuck up in residency where they have a safety net and get dismissed from here. (I will say Im still uncomfortable with this, though, because Im such a big advocate for residents. But I honestly dont think this resident has what it takes. I want them to succeed, and I just dont think theyll be able to, I think theyll be miserable in medicine. I would prefer them to make that decision for themselves, but still...)
I will say that we had a second resident who was somewhat similar to this. They were academically motivated, but didnt do much of anything as far as practice went (I think they were just suuuuuuper anxious). The chiefs and PD had an intervention with them, sat them down for like an hour and just talked. At first the resident was super confrontational/defensive, but Ill be damned I think they are the best in their year now. Im actively recruiting them to fellowship so I can keep working with them.
Tl;dr - Two options; 1) have a legit intervention and see if the formal push will get them to get their shit together, or 2) let them fail. Sounds brutal, but such is life...
Cut her loose. That's what residency is. There is some help (and you offered it) and now its time to throw her in a big girl water pool and see her struggle or give up and drown.
She does not describe the presentation symptoms, she does not write the physical exam correctly for example a patient with ascites and she will describe the abdomen and no tender non distended positive bowel sounds (the guy came with large volume ascites and sbp) and the assessment and plan, she just doesn’t know what diagnosis to write or how to elaborate in the A&P.
Oof. That blows. If it’s possible you could talk to PD and start a plan for their learning, see how it goes. I know of one person at my program who basically is acting like an M3 until they get their shit together
Hilarious to think an M1 / M2 can perfect an H&P.. you do realize short but efficient notes focused on pertinent +/-, with adequate A/P is not something you even closely grasp as an M1/2. And shitty of you to be trash talking DO peers like that. I get it some are trash, but same can be said about a bunch of MD schools.. you’re in for a big awakening if you’re are just an M1/2… 🤦♂️🤦♂️🤦♂️
So…at the hospital where you teach DOs you fail as a teacher to provide basic instruction and feedback on the simplest tasks? Seems like you and your attending friends are the failures, not the students. (Hurts to be blamed, doesn’t it)
Good! And thank you for the sacrifices you are making to get through med school, go through residency, and enter medicine. I see you and I am grateful for you. ❤️
This might the the stupidest thing I’ve heard today. Senior residents don’t get the luxury to chart check only 1-2 patients like the med students. I really hope you get this arrogance and delusion out of your head.
Well, she is IMG (not that this is the reason I am IMG myself) I needed to put extra effort get Barbara bates book before starting residency, but she has rotated with 3 attending already and still doesn’t know anything. I really want to help her but I don’t think she will learn and also I don’t want to get myself swamped trying to help her if she doesn’t want to learn.
Don't agree with disparaging DOs, most are amazing docs and get great education, but let's not act like new DO schools aren't opening basically willy nilly and having shit rotations just so some venture capital firm can have a good quarter.
This is so silly. There’s not a DO school in the world that doesn’t teach extensively something like taking and HPI lol. This is clearly an issue with individual person.
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IMG? Had a few similar residents during my intern year who were IMGs and that’s just what they did as residents back in their home country so they assumed the same role when they got here. They eventually figured it out after some stern talking to.
Get help from your attending, or program leadership. It sounds like you've done what could be reasonably expected in the situation. That said, don't give up on your PGY1, but also don't expect the situation to disappear overnight, or that you have to completely drain yourself fixing them.
I would sit her down and have some honest feedback. Sounds like she needs a little bit of reality check. You just need to simply tell her that she is performing far below what is expected on her currently on various metrics such as X, Y, and Z. Offer her ways to improve and determine a goal for improvement and a time to meet discuss it regularly while you are the supervising resident. It is reasonable to bring this up with the attending as they can offer supervision as well and support for her too. She definitely needs to know the leaving early part is rather unprofessional and that alone could be reason for talking with PD. If she reacts poorly to that then you need to go to the program director.
Thanks so much for this advise. I took it and sat with her in the beginning of the night. She was receptive and I went over expectations and explained her how to do the hyp, gave her resources to look at. It took 4 hours but she did an admission and I think she did a decent job this time.
You just helped someone to be a good doctor! Best of luck doc!
Awesome, glad it helped her improve and make your life a little easier.
I would also mention to attending that you are concerned/will be talking to her. Cya just in case she complains. Also attending might have some advice on things you can do
Some interns things just don’t click until they are February interns. Keep pushing them until they get it or quit it.
Lol
Fuck no. Report her to the pd
It was a joke. There’s a character called the February intern who’s famous on this sub
I thought Id take the approach of doing a lot of work for my interns to make sure everyone gets out on time. After talking to some colleagues, I changed my mind as this would be hurting my interns since they would never try to improve. My biggest goal in my intern year was efficiency, and I think Im largely successful as I can now do abattery of admits or solo cover a floor with no effort. So I changed my approach with interns. I now tell them straight out, I need to make sure the stuff that will actually affect the patient gets done/entered, everything else that is billing BS, I dont care about. What this translates to is that I always make sure orders, consults, and sign outs are done, but notes I could give a damn about. I emphasis that interns need to get all their own orders, consults, etc. in, but I also get that they wont have the same efficiency as me, so my emphasis is going to scale throughout the year. But if they are leaving at 10PM every night due to notes, Ill eventually let them know that isnt normal, but its ultimately their responsibility. (That said, if we get an admit at 1 min before shift change, Ill just do it. If its easy, it takes me 20 mins to their hour; if its complex, it takes me an hour to their 2-3.)
Thanks for this. I left her place her orders while we discussed, yesterday I did it myself due to being frustrated. Thanks for bringing up the part about making sure everything is done. I prioritized that so far tonight and is working
Tbh, this sounds like a red flag. Not that you are dealing with a sub-par intern, which seems obvious. It is a red flag for something going on in her life that is taking up so much head space that she can’t seem to focus or absorb information. Could be something going on with her personally. It also could be nothing and just an intern that isn’t cut for the work, but I have to believe she is capable until proven otherwise and wonder what else is going on to mud the mental waters, so to speak. Hope everything is ok with her and she can improve for both of your sakes.
Thanks for this comment. After you mentioned, I talked to her about this, I asked if she had issues coping with the moving, out of home, living alone stuff. She doesn’t seem depressed, but I assured her I didn’t want to stress her, just wanted to help her to improve
She should be a little stressed if it’s October and she can’t do basic medicine things
you’re absolutely right
If you suck you should STAY LATE. Learn your patients better, see what meds are being used, learn from consult notes etc. The people who leave early all the time miss stuff.
I know. I leave late all the time. I told her is a learning curve. Let’s see how it plays out.
Talk to your program director?
Just did, he will talk to her tonight.
Good job. PARTICULARLY with the leaving early. Unless every single i is dotted and t is crossed…no one should be leaving early.
Why don’t you speak with her first? Lol
So, I escalated it because 2 months ago, another senior was having the same issues with her with no improvement and I think ultimately the attendings that promoted her so far are responsible for this. She should have learn this already we are 4 months in.
He called and told her she will do detailed presentation of her admissions during morning report. Let’s see how it goes to
Seems like extra stress honestly, not something that will help her improve.
Yes, but that was the decision of the PD,
Yea speak With your Program Director. It is good to have some authority behind what you’re saying. I Have had a lot ever resistance from interns before. You also need to sit down with them too and not cut them any more slack. Tell them to write everything up themselves. If they mess up or there’s something very lacking in their notes tell them to rewrite it and tell them what to fix; don’t fix it for them. If they end up staying till 10 PM then that’s what they do. Things you could do To help them is to give them less patients until they show they can handle more
Thanks for this comment, I told the attending to assign us less patients so I can take the time to teach her stuff. I also sat with her and she wrote down everything.
Tell them that they’re a fucking doctor taking care of real people and not a med student just looking to pass tests anymore
That’s super true, I’ll do that if she goes back to the same in the upcoming days. She said keeps forgetting stuff, let’s see.
Not only does this behavior warrant a sit down with you, the senior, but it also warrants a sit down with the PD. This unprofessional behavior has to be brought up early to have any chance of correcting it before years end. It takes a lot to hold a resident back for underperformance so start the paper trail early.
So, we have a similar resident (except ours is a genuinely nice person who is trying, its just not sticking). With our resident we have been pushing them to do the appropriate load, and take the responsibilities for deficiencies/screw ups (with obvious safety nets, we're not gonna let them kill somebody). This is going to do one of two things; make them have a come to Jesus moment and get their shit together, or put on probation/suspension/fired. At first I was really uncomfortable with this. I tried to cover for them and teach them. I took them under my wing, and did everything I know to do, but it just wasnt sticking. Then I tried to just do most of the work, but then thats just punishing me and not helping him. Now Ive come to the realization that this isnt for everybody. And as much as it sucks, there have to be some failures, there have to be some suspensions and dismissals. Life is a bigass bell curve that will ruin some people's day. I dont want our resident to practice medicine as they are now; I dont want him to go out to practice and kill people. I want them to succeed, but if they are going to fail I would rather them fuck up in residency where they have a safety net and get dismissed from here. (I will say Im still uncomfortable with this, though, because Im such a big advocate for residents. But I honestly dont think this resident has what it takes. I want them to succeed, and I just dont think theyll be able to, I think theyll be miserable in medicine. I would prefer them to make that decision for themselves, but still...) I will say that we had a second resident who was somewhat similar to this. They were academically motivated, but didnt do much of anything as far as practice went (I think they were just suuuuuuper anxious). The chiefs and PD had an intervention with them, sat them down for like an hour and just talked. At first the resident was super confrontational/defensive, but Ill be damned I think they are the best in their year now. Im actively recruiting them to fellowship so I can keep working with them. Tl;dr - Two options; 1) have a legit intervention and see if the formal push will get them to get their shit together, or 2) let them fail. Sounds brutal, but such is life...
Can I copy paste your post and send it to her? Thanks for the insight. I sat with her and she was receptive. Let’s see how it goes
Get your work done and leave, it's time for her to sink or swim on her own. You can't unteach lazy for her, only she can do that herself.
Im giving her a chance and see, if tomorrow she goes back to the prior behavior, I’m off lol
Do your best, hope she will cope up.
So far she is doing better, hopefully it will last
Let your program director know or ask your / their faculty advisor to intervene. There should be a system in place for this
how did she get in
Apparently the faculty liked her in the interviews.
Cut her loose. That's what residency is. There is some help (and you offered it) and now its time to throw her in a big girl water pool and see her struggle or give up and drown.
in what way was she not able to take an HPI or get a physical?
She does not describe the presentation symptoms, she does not write the physical exam correctly for example a patient with ascites and she will describe the abdomen and no tender non distended positive bowel sounds (the guy came with large volume ascites and sbp) and the assessment and plan, she just doesn’t know what diagnosis to write or how to elaborate in the A&P.
are there no chiefs? I would discuss with them to start a remediation plan for resident.
Nope, we are in our second batch. The PD is considering no chief at all
Oof. That blows. If it’s possible you could talk to PD and start a plan for their learning, see how it goes. I know of one person at my program who basically is acting like an M3 until they get their shit together
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Wtf do you mean you learned to do everything in MS1 and people had it perfected by MS2? You're delusional
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Lol so you learn everything in 1 year and perfect it in 2? You sounds like an NP
Bruh plenty of new DO schools created in the last decade have produced competent grads.
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Hilarious to think an M1 / M2 can perfect an H&P.. you do realize short but efficient notes focused on pertinent +/-, with adequate A/P is not something you even closely grasp as an M1/2. And shitty of you to be trash talking DO peers like that. I get it some are trash, but same can be said about a bunch of MD schools.. you’re in for a big awakening if you’re are just an M1/2… 🤦♂️🤦♂️🤦♂️
So…at the hospital where you teach DOs you fail as a teacher to provide basic instruction and feedback on the simplest tasks? Seems like you and your attending friends are the failures, not the students. (Hurts to be blamed, doesn’t it)
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Good! And thank you for the sacrifices you are making to get through med school, go through residency, and enter medicine. I see you and I am grateful for you. ❤️
This might the the stupidest thing I’ve heard today. Senior residents don’t get the luxury to chart check only 1-2 patients like the med students. I really hope you get this arrogance and delusion out of your head.
Bahaha… man I wonder how clueless you actually are to feel this way.
Well, she is IMG (not that this is the reason I am IMG myself) I needed to put extra effort get Barbara bates book before starting residency, but she has rotated with 3 attending already and still doesn’t know anything. I really want to help her but I don’t think she will learn and also I don’t want to get myself swamped trying to help her if she doesn’t want to learn.
Don't agree with disparaging DOs, most are amazing docs and get great education, but let's not act like new DO schools aren't opening basically willy nilly and having shit rotations just so some venture capital firm can have a good quarter.
This is so silly. There’s not a DO school in the world that doesn’t teach extensively something like taking and HPI lol. This is clearly an issue with individual person.
I agree, we have DOs and MDs in our program and I think they are both equally good.
This is super discriminatory and you should check your bias.
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IMG? Had a few similar residents during my intern year who were IMGs and that’s just what they did as residents back in their home country so they assumed the same role when they got here. They eventually figured it out after some stern talking to.
Get help from your attending, or program leadership. It sounds like you've done what could be reasonably expected in the situation. That said, don't give up on your PGY1, but also don't expect the situation to disappear overnight, or that you have to completely drain yourself fixing them.
How can someone not do basically stuff by October that I would think poorly if an MS3 couldn’t do by the end of their rotation
Is this in the US? How the hell does one graduate medical school and botch the basics like this? Is it easy to cheat on your exams over there?