I Am Caught In An Early Vicious Cycle: Help!
Hello Dr. Julius,
I found your article about the struggling radiology resident and looked at your previous answer to a similar question I have. I am an R1. And, at the end of October, the program informed me that I was struggling and having problems with synthesizing information as well as problems with communication. Since then, they let me know that I haven’t improved and am still behind my peers.
I know that you mentioned getting out of the of the vicious cycle will be difficult, but I feel that every time I’ve spoken with my PD or assoc PD they feel my problem is inherent and I can’t be a radiologist. I’ve seen a psychologist for help, and in seeking information I accidentally got the GME involved. I’ve been studying harder, but my confidence is shaken and I keep missing things and not improving. I am concerned that they will fire me. Where do I go from here? Do I start looking for another specialty or do I stick it out until they’ve had enough and will not renew my contract?
Dear Scared R1,
Before anything else, you need to ask yourself if you have really been putting in many hours of studying each day and you have immersed yourself in the field of radiology. If you are honest with yourself and have truly been putting everything you have into learning radiology, you shouldn’t be so hard on yourself. I am going to assume in your case that this is true.
So, what is it that bothers me most about your situation, the way you are explaining it? You said you just recently started as an R1. That would mean that you just began the second half of your first year. And yet, it seems that you assume that your PD and associate PD think that inherently you will not make it through your program?
It would be extremely unusual for a PD to know that you can’t make it through your residency so early on. In my experience, I have had several residents that had a questionable first year, only to discover that they became more than proficient when they started on call. Typically, it is only by seeing how you do on call that they can know. (assuming you passed a precall assessment) So, it seems to me that they haven’t even given you a chance. From what you are saying, you may be in the midst of an early vicious cycle.
Second, the ACGME requires the program director to give you an opportunity to remediate your situation. They can’t just indiscriminately fire a resident without due process. And, since you have barely started radiology, there is no way that you could have had an adequate opportunity to remediate the situation. Again, this all assumes that you have not done anything to endanger your patients or fellow staff that would require them to prevent you from working.
So, where does this leave you? Well, improvement is an incremental process with occasional setbacks along the way. You may feel like you are not improving, but, in fact, you actually are. The key is to learn from your mistakes and not to repeat them over and over. It’s ok to have missed at this point. You certainly can’t expect a first year to not make any mistakes.
All this being said, occasionally there are some residents that can’t cut it. But, these residents are rare and I certainly would not be ready to pack it in just yet.
At this point, you should view each mistake as a learning opportunity, not as something to get discouraged about. I think you need to stick it out with some grit and determination to try to get through this difficult time. Radiology residency can be very tough for first-year residents. Staff can be unforgiving.
Improvement is a gradual almost imperceptible process in any small time frame. In a longer period, you may begin to notice the changes from reading and studying. Continue to soldier on and let me know how things go!
Barry Julius, MD
Hello Dr. Julius,
Thank you for the encouraging reply. In your experience, what is the usual time frame for struggling residents to see improvement? I’ve so far finished four weeks on a must-cover and my attendings state that I am not improving. I have another 4 weeks to go, but I am concerned that if I haven’t improved much in the first 4 weeks what are my chances of improving in another?
4 weeks is a very short amount of time to assess for global changes/improvement. If we are talking about more specific goals that you have set, then that would be more appropriate. Based on what you are saying, it is hard to determine what improvements they are trying to assess. Global assessments don’t work too well. In fact, I am writing an article talking about that. On the other hand, incremental specific goals should and can be assessed. Hopefully, they are creating these for you and/or you have created some for yourself. You can certainly reach specific smaller goals within a 4-week block of time if these goals are appropriate.
Barry Julius, MD