Worried About Dismissal Due To Bad Evaluations: How Do I Keep My Radiology Residency Position?
Hi Dr. Julius,
Big fan of your blog. I come here often for tips on how to be a better radiology resident. So I wanted your advice on a dilemma I’ve had.
I am currently a third-year resident. Since the beginning of the first year, certain attendings have raised concerns about me, specifically regarding my medical knowledge and procedural competency. The overwhelming majority of my evaluations have been mostly positive. However, the CCC have mainly picked on the negative evals. I had some struggles in Fluoro first year. At the end of that year, I was placed in a remediation program, basically assigned some radprimer modules, which I successfully completed. I repeated the fluoro rotation my second year and had positive reviews with everyone saying I was at level and receiving positive evaluations. One of my ER attendings felt that I have trouble synthesizing information. However, the others thought while I was not a superstar, I was appropriate for my level. At the end of last year, the CCC committee thought that in addition to GI/GU, I also needed help in Neuro but given that I had scored over 30% in the in-training examination, I did not officially qualify for the program, however, I met with the assigned Neuro attending a couple of times. However, due to the third year being busy with call, AIRP, and outside pediatric rotations, I haven’t had a chance to meet with her after the first month but I have independently been working on the radprimer modules and doing them on my own. Most recently, I completed an IR rotation (Ir is something I am interested in, and I did receive 2 rec letters from 2 different IR attendings). At this rotation, the techs complained about my professional behavior (which I have never had any issues in the past with any other tech from any other modality). Basically, I was frustrated getting about being scutted out of procedures to get H&Ps and consents. In a fit of rage, I had given extremely poor evaluations of the rotation techs and attendings alike. So, this time the attendings have rated me poorly as far as poor evaluations questioning my medical decision making and procedure skills. I want to say that I busted my ass this time around, kept my mouth shut, and did what I was told but in the end that did not help me.
So I am extremely concerned about the CCC’s decision regarding my future. The CCC meets at the end of this month. I’ve been meeting my program director every week to go over stuff in terms of him helping me remediate, etc. I am not officially on probation. I heard through the grapevine that at the last meeting, 2 vocal attendings were pushing for my dismissal/probation. I want to also mention that prior to the IR rotation, the GI/GU rotation attendings had given me positive evaluations, which put me at appropriate for my skill.
So I am sorry for the long-winded post, but I am extremely worried about being dismissed by the CCC. What kinds of steps should I take? Should I meet with the GME committee, should I write the CCC a letter explaining my side of the events? My misses have been at par with other residents my level, however, the perception is that I have missed a lot. Should I try to get the attendings who have written me positive evals to send to the PD?
Would very much appreciate your help!
I also should point out that 2 residents failed last year in my program including the current chief. Just think the education is not that great, so again I think they have even more reason to fire me as they think I will fail.
Sorry for using a pseudonym.
Dear Helpless Rad,
Sorry to hear about your tribulations over the past few years. But, think of it this way. All these events have the potential to make you a much stronger radiologist.
Based on your story, it seems like you have hit something called the vicious circle (the opposite of the virtuous circle) detailed in my previous blog called The Struggling Radiology Resident. Basically, once a few attendings think that your performance is not up to par with your colleagues, these vocal attendings often spread the same sentiment to the other attendings. And, poor evaluation and expectations from many attendings subsequently ensue. Often times, this happens regardless of your “true performance”. Unfortunately, the new evaluation milestone evaluation system (meant to prevent this dilemma with global assessment) does not stop below-average recommendations from these staff members even though you may exhibit improvement.
In any case, let’s get to how you can begin to stop the dilemma of the vicious circle. (It’s not an easy or short process!) First thing, you need to take immediate action. Figure out why your attendings think that you have problems synthesizing information. Is it related to former errors that you made during a call that you have already corrected, now that you are more senior? Was it a personality issue? Or, is there a deeper seeded learning issue? Over the years, I have had a few residents that had learning disability issues that only came to light when they started radiology since the learning skills are so different from other specialties and medical school. You really need to figure out what the base issues are. If you are not sure, you may want to talk to your attendings to find out exactly what they think. Talk to both the attendings that favor you and those that you think do not. Then, based on you and your attending’s assessments set up your own plan for remediation. Afterwards, give the plan to and meet with the clinical competency committee so that they can see that you are trying to take action to improve. Finally, check to see that it matches their plans and expectations. That will go a long way toward showing you are proactive.
By the way, I would try to avoid going through the GME. You want to make sure that the issues stay within the department if possible. To that end, it sounds like you are not at the level of a GME issue such as probation. Going above the level of the clinical competency committee means that this becomes a hospital-wide issue rather than a departmental issue. That can lead to further hard feelings between you and the department. Of course, in certain abusive situations that may be necessary. But from what I think you are saying so far, it sounds like you can probably contain the damage to your own department.
Also, it sounds like you committed one of the cardinal errors of someone who has little experience in the workforce (unfortunately many medical residents are in that category since their first job is in medicine!). You tried to enact revenge on those that gave you bad evaluations by giving them bad evaluations. As you can see, that typically gets you into hot water. As a resident, you are at the bottom of the totem pole, and that will always make your situation a lot worse. It just does not work! Always be careful what you put into writing no matter what someone else says about you. It sounds like you will not make that mistake again!
Finally, you need to understand that it will take a long time to repair the vicious circle. Do not expect your faculty to change their thoughts about you for a long time. It is only after many months or even a few years of hard work that you may sway them to your side. It’s a long road, but your job is to ignore what they may think of you now. Just keep on plugging away and improving bit by bit. Eventually, you may get some of these attendings to understand that their former opinions of you were entirely unfounded.
Hope that helps and let me know if there is anything else I can help you with,
Barry Julius, MD