It’s important to proactively manage your resident progress. Here’s how.

Physician training is an extremely high stakes business, not only for the patients that will be under the care of the eventual independent, fully-trained, board-certified doctor, but for the trainee herself. The financial and time costs of the entire training process are enormous. To become derailed from the board certification path can have significant and permanent career consequences. With so much at stake, what does a resident do when she runs afoul of her program or its director?

Without concentrating too much on issues of fault, we’ll assume that in most instances of resident trouble, they are due to legitimate deficiencies. However, even in our current day, there are dysfunctional programs and attendings out there that cause resident harms, that subjectively target, defame, retaliate against a complainant, discriminate, ignore accreditation requirements for evaluation and due process, and worse. Regardless of the etiology of resident distress, trainees should be assertive in knowing their standing in their program and in managing their image and progress.

Too often, residents start to engage in their defense far behind the proverbial eight ball, too late to make an effective move for their own cause — perhaps an unsubstantiated poor evaluation went unchallenged, or a misunderstanding with an attending was allowed to fester, or a probation with inadequate terms was too readily accepted, or a termination notice has been issued. In some cases, it is too late to salvage the current training path. With a more assertive approach, how many residents might have altered their course?

Some ideas for managing your residency progress: Know what is in your resident file. Read your program director’s notes found in it. Stay on top of your evaluations. Review your Milestones rankings. Address anything untoward immediately. Talk to attendings about your progress, and ask them for their opinions on your standing and on potential areas for improvement: “Just being proactive.” Ask them for advice. Get a mentor that cares about your progress. Know who is on the core curriculum committee and develop professional relationships with them. Show interest and engagement, knowing that you are always under the microscope and that perceptions sometimes matter more than realities. If areas for improvement are identified, develop a plan and make sure multiple attendings know about it.

As important as any of the above, is to document for yourself what you do, to whom you speak, what they say, and when you meet. God forbid, if things do seem to be turning against you, act early to engage other resources. The resident ombudsman can be contacted through your office of graduate medical education. This person should be an advocate for you, can accompany you to meetings in which you need a power equalizer, and guide you through any necessary institutional processes.

In the rare instance that you suspect foul play, especially which may affect your standing, consider some options for filing appropriate complaints. Depending on the infraction, you might submit a grievance to the hospital medical staff office, hospital risk management, the dean of student services, the ACGME, the state medical board, or others. Of course, filing a complaint, even though anonymously, can often be traced back to the complainant. Once identified as a troublemaker, gasoline has been added to the fire, and retaliation can become an issue.

If conditions are deteriorating, speaking with an attorney early can be helpful for advice and potential intervention. Finding an attorney experienced in resident training can be difficult. This is an area that seems to straddle employment and education law, which few have navigated well. An additional concern is that of expense. Burdened with six-figure debt, living off of a resident stipend, and working a large number of hours all leave a resident with little disposable income or time to engage legal services. However, even a consultation with an attorney may offer some valuable insight.

The takeaway message of this article is to proactively manage your resident progress. Do not trust that others will do this for you. In some instances, residents have even found quite the opposite — sabotage, gaslighting, and damaging gossip. Showing up, doing the work and studying may not, in themselves, get you through successfully. There may be obstacles (self-imposed and otherwise) that present themselves along your path. You’ve come a long way and have a significant investment in yourself. Get busy protecting it.

Todd Rice is an anesthesiologist and creator, Graduate Medical Education Compliance Project.

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