Question:
Hello Dr. Julius,
I found your article about the struggling radiology resident and looked at your previous answer to a similar question. I am an R1. At the end of October, the program informed me that I was struggling and having problems with synthesizing information and communication issues. Since then, they told me I haven’t improved and am still behind my peers.
I know that you mentioned getting out of the vicious cycle will be difficult, but I feel that every time I’ve spoken with my PD or assoc PD, they think my problem is inherent and I can’t be a radiologist. I’ve seen a psychologist for help, and I accidentally got the GME involved in seeking information. I’ve been studying harder, but I have a shaken confidence. 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 stick it out until they’ve had enough and will not renew my contract?
Name
Scared R1
————————
Answer:
Dear Scared R1,
Before anything else, you need to ask yourself if you have been putting in many hours of studying each day and have immersed yourself in radiology. If you are honest with yourself and have genuinely 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 bothers me most about your situation is how you explain 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 highly 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 who had a questionable first year, only to discover that they became more than proficient when they started on call. Typically, they can know only by seeing how you do on call. (assuming you passed a precall assessment) So, it seems they haven’t even given you a chance. From what you are saying, you may be in the midst of an early vicious cycle.
Remediation of the Vicious Cycle
Second, the ACGME requires the program director to allow you 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 you could have had an adequate opportunity to remediate the situation. Again, this 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 you are. The key is to learn from your mistakes and not repeat them repeatedly so that the vicious cycle continues. It’s ok to have missed at this point. You certainly can’t expect a first-year not to make any mistakes.
All this being said, occasionally, some residents 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. You need to stick it out with some grit and determination 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. You may notice the changes from reading and studying in a more extended period. Continue to soldier on, and let me know how things go!
Sincerely,
Barry Julius, MD
——————–
Question About Improving The Vicious Cycle:
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 finished four weeks on a must-cover, and my faculty state that I am not improving. I have another four weeks to go, but I am concerned that if I haven’t improved much in the first four weeks, what are my chances of improving in another?
Sincerely,
Scared R1
———————-
Answer:
Scared R1,
Four weeks is a concise amount of time to assess for global changes/improvement. If we are talking about more specific goals you have set, 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. I am writing an article talking about that.
On the other hand, programs and residents can assess and create incremental specific goals. Hopefully, they are creating these for you, and you have made some for yourself. You can undoubtedly reach specific smaller goals within a 4-week block if these goals are appropriate.
Barry Julius, MD
