The Other Struggling Radiology Residents

A radiology residency program is like a family. When one person is afflicted academically or professionally, all of its members suffer down the road. Just as important as it is to be aware of and help the struggling radiology resident, it is also important to remember that one struggling resident can have serious repercussions on the remainder of the radiology residency program.  It is not just the program director and chairman that reap the consequences of the struggling resident.  Often times unfairly, it is the class members that take up much of the additional burden, whether it be extra call shifts, less time spent on educational rotations, uncomfortable personality conflicts,  or extra time spent educating the failing resident. So, this post is dedicated the other radiology residents that are affected by the struggling radiology resident. First, we will go through how other residents can appropriately identify and help the struggling resident and possibly get this person to the attention of the program director. Then we will go through what a resident  should and should not do when there is a resident struggling either academically or professionally. And finally, we will examine how the residency program should commit its resources toward the struggling resident vs. the other radiology residents.

Identification of Struggling Resident by Colleagues

Many times the first residency program members to notice that a resident is struggling is not the program director, chairman, or attendings, but rather the struggling resident’s fellow colleagues. Fellow residents are more likely to interact with the struggling resident on a social basis in a more comfortable setting where the struggling resident is more likely to discuss his/her issues.  This is an opportunity to learn more about how your fellow classmates are feeling about residency. They may even ask for your help. My advice is: give whatever help is reasonable to your classmate so that they can perform well. Residency is not a competition, it is a team environment. In addition, the help that you give your fellow struggling resident will come back to you many times over. Whether you decide to teach your colleague or help them out with other residency issues, you will find that you will learn more about your material and yourself. Even better, you may be able to stem a progressive downward spiral to probation or even worse, a point where you and your classmates would suffer more dire consequences.

Sometimes the identification of the struggling resident may be a bit more subtle than a simple comment to you about their struggles. Different from an attending that sees a resident on one noon conference or on a single day, you as a fellow resident may notice a pattern of taking cases and missing all the findings each time or multiple absences that are not recorded by the program. Or you may notice bad habits such as drinking a little too much, something a little bit off, or a strange affect. These can be important sentinel events and you may want to address the issue with your program director’s or chairman’s attention to make sure the struggling resident gets the help that he/she needs.

In the end, it really pays to identify the struggling resident. Remember it often affects not just that resident, but the entire program as well.

How Can The Residents Help With The Academically Struggling Resident?

It is the primary responsibility of the program directors, attendings, and chairman to handle the academically struggling radiology resident. But, for the struggling resident’s rehabilitation to succeed, the program often needs to have the participation of all. In fact, the role of the other residents can be the key for the stability of the program through this trying time as well as increasing the likelihood that the struggling resident will eventually succeed.

Prior to any remediation, it is important to determine if the struggling resident is willing to accept the help of the other members of the program. So, the role of the other residents can only begin when the struggling resident asks for help from his/her fellow colleagues. You certainly cannot force a struggling resident to take participate in remediation efforts if the struggling resident is not willing or able.

If you remember the previous article- The Struggling Radiology Resident, we discussed how the academically struggling radiology resident may have difficulty with coping with the quantity or quality of his/her work. So, I will go over briefly how the other residents should attend to each of these issues.

For a struggling resident that is unable to schedule appropriate time for studying , what should his/her colleagues do?  This becomes a time management issue. It would be appropriate to help the struggling resident to create a schedule for themselves. Sometimes it helps just to sit down with the struggling resident and show them how you schedule your study time and what you have been reading on each rotation.

In the case of a struggling resident that has difficulty with quality of studies, it would make sense to have group study time and to present cases to one another in order to improve taking cases. Or, it may be a good idea to go over questions with all the residents to practice testing skills. These processes not only helps the struggling resident but may be  good practice for the entire team.

How Can The Residents Help With The Professionally Struggling Radiology Resident?

When it comes to a professionally struggling resident, the fellow residents have to be a bit more careful with assisting in interventions. Obviously, the intervention will depend on the  primary cause of professionalism problems.

For the resident that is often absent, it may be possible to address this issue by simply asking the resident where they have been or why they have not been around in a non-confrontational manner. Sometimes the struggling resident may not be aware of the burden he/she is placing on the other residents. This may make this resident aware of the issues he is causing and take responsibility for his actions. Again, if this does not work, it may just be as important to bring the issue to the program’s attention.

For the resident with personality issues, whether it be a resident that is abusive or a resident that is unengaged, you need to be a bit more careful. If you are friendly with this resident, by all means it does not hurt to find out if there is an overall cause for the behavior. But be careful to not be overly intrusive as it may not be appropriate to get involved much further. Certainly, if the struggling resident is amenable to helpful suggestions of conflict resolution within the residency, talk to this person about some of theses issues in an appropriate setting. Or, it may be  appropriate to make a suggestion to this resident to seek professional help if the resident is amenable.

In many programs at one time or another, just like the general population, some struggling residents will experience psychiatric issues or may be involved with alcohol or illicit drug use. These situations can be extremely touchy. Many of these residents may not have insight into their problems and are more likely to refuse help from colleagues or attendings. Of course, a few may have insight. But, if you notice a struggling resident with one of these issues, it is usually best to bring the issue to the attention of the program director or chairman of the department so that they can get the resident into the appropriate channels for treatment. Of course, there are exceptions to every rule. And on occasion, the struggling resident’s colleagues may have intimate knowledge of the resident and may be more likely to be able to get the resident appropriate help. But, be careful in this situation because there can occasionally be unforeseen legal and professional ramifications to the caring colleague. A resident without insight into his/her problems may see this helpful resident as antagonistic and can theoretically pursue these channels.

How to Commit the Program’s Resources Toward The Struggling Resident

Over my tenure as associate residency director, I have learned that dealing with the issues of a struggling resident can be a drain on a program’s administration and resources. Time that is normally spent toward improving the residency program, instead needs to be placed on the issues of the one resident. Especially in smaller programs with less faculty and monetary resources, the time spent can overwhelm the program directors, chairman, and heads of Graduate Medical Education.  While it is important that the struggling resident gets the necessary help and remediation, we have to remember that other residents also need to have a functional residency program. It is easy to forget about the other residents in this process. So, it is the residency director and chairman’s role to place additional efforts to also concentrate on not just the struggling resident, but the other residents at these times and to make sure the residency program continues to run smoothly.

Back To The Other Residents

Every program at one time or another will have a struggling resident. And, it is important for fellow resident colleagues to help out if possible with the identification and remediation of the struggling resident. But, it is often the other residents that suffer most from the consequences of a struggling resident’s actions and inactions as well as the choices that the administration make to help the struggling resident. So, everyone involved needs to make a concerted effort to not forget about the the struggling resident’s colleagues. Or else, these residents can truly become the “other struggling residents”.