Racism in residency programs.

[anonperson]

Can you give me any data showing that test scores correlate with anything other than other test scores?

And even if they do...the logical next question is why you think URMs perform worse on standardized tests or clinically. The two options I see: (1) you believe they are inherently less intelligent, worse test takers, lower in aptitude for the job of being a physician, or (2) there is some sort of external factor, like, I don't know, systemic racism, that makes it harder for URMs to be successful on those measures.

Am I in some bizarro world?

This is the medical field. Standardized tests are used to determine minimal competence ALL the time. MCATs, USMLEs, ITEs, and board certification exams. The list goes on. The people who do poorly on those tend to have a poor fund of knowledge and GENERALLY aren't great at their job. They may be very nice, personable even charismatic but probably not the best at their job.

Standardized tests are a very reasonable surrogate marker for competence. If you can't accept that, then there is no point in arguing.

In OBGYN, the in service exam is correlated with passage of the written board exam. If you feel that's just another Standardized and unfair exam the American Board of OBGYN strongly disagrees with you as do I. I have worked indirectly with some non boarded OBs who are not good at all. There is a reason they can't pass.

Show me a resident who fails the written exam and I'll show you a incompetent resident because that is the bare minimum baseline knowledge.

I don't know why certain URMs score poorly on Standardized tests because plenty of minorities with non English backgrounds who are more recent immigrants to the US seem to do fine.

I grew up with brown skin, foreign name and 2 parents who didn't have English as their first language since they recently immigrated. The deck was certainly stacked against me but I don't need to cry racism if I didn't do well in an exam because it was never the case.

Explain to me again how Step 1 is racist but only against certain minorities because the test turns non racist to East and South Asians?

My point that I have tried to emphasize comes down to this:

There are more URMs in medical school with lower MCAT scores and GPAs compared to their peers. Medical schools will admit weaker students to increase diversity. That is their right. They don't want a class dominated by Whites and Asians.

Some of these weaker students will flame out as the training gets more intense. This is not some racist idea. Some programs may try to salvage these residents while others will cut their losses.

If you have a URM who has a 3.9 GPA and scores in the 90th percentile in the MCATs, this will probably carry through and I would expect them to be a strong resident.

---

Members don't see this ad.

 

[operaman]

I'm not saying boards or test scores are useless - they're certainly not. However, they were originally designed to ensure a MINIMUM level of competence, as you said yourself above. If you look at what USMLE scores are actually correlated with pretty good ITE/specialty board pass rates, it's generally a score that's well below average and not far above passing - across specialties, there's not a big difference between someone who scored a 210 and someone who scored a 240 on that measure. Moreover, if these types of stories were coming out and all of the dismissed residents had failed a test somewhere along the line, I'd probably be singing a different tune - but that's not the case. These residents are getting dismissed based on subjective things.

I have asked you to provide data on correlation between test scores and clinical performance. You have not.

I have also asked you to answer WHY you think URM students/residents are more likely to perform poorly on standardized tests. You have not.

"Explain to me again how Step 1 is racist but only against certain minorities because the test turns non racist to East and South Asians?"
This is a pretty significant oversimplification of the point I made lol, and I think if you re-read my post you were replying to you will find the answer (hint: it's #2). Yes, Asian students also face racism, but it's a little different than the type of racism that URM students face, e.g. model minority myth. And regardless to the answer to that question, my question to you still stands as to why YOU think URM students tend to perform worse on standardized tests or clinically.

I think the disparate test performance can largely be explained via selection bias. And really that isn’t the issue here.

It’s not: black people do worse on tests than asian people.

It is: the black people admitted to medical schools tend to have lower scores than the asian people admitted to medical schools. For this we have pretty compelling objective data.

While I cannot answer the bigger question of why black people score lower on tests than asian people, I think it’s pretty obvious why the black people admitted to medical schools score lower than the asians admitted to medical school:

The black people who scored or would have scored as high or higher elected to pursue different fields than medicine. Their reasons for picking other fields may partly be related to a perception that they would face discrimination in the medical field, or possibly they found other paths (tech, finance) more lucrative and interesting.

Either way, we are left in medicine with finely selected groups that begin with objectively different levels of aptitude. I suspect that if we compared black and asian outcomes and only looked at people above certain score cutoffs, essentially controlling for entering aptitude, we would see much more similar outcomes.

 

[anonperson]

I'm not saying boards or test scores are useless - they're certainly not. However, they were originally designed to ensure a MINIMUM level of competence, as you said yourself above. If you look at what USMLE scores are actually correlated with pretty good ITE/specialty board pass rates, it's generally a score that's well below average and not far above passing - across specialties, there's not a big difference between someone who scored a 210 and someone who scored a 240 on that measure. Moreover, if these types of stories were coming out and all of the dismissed residents had failed a test somewhere along the line, I'd probably be singing a different tune - but that's not the case. These residents are getting dismissed based on subjective things.

I have asked you to provide data on correlation between test scores and clinical performance. You have not.

Who cares what the USMLES were originally designed for?

No one uses them like that. If the USMLE truly believed that, they would never report a score and just a pass/ fail.

They offer a score because we all know that a higher score means someone has a better fund of knowledge.

Ortho, plastics, and derm PDs all believe this. IM PDs at top tier programs also believe this as many have cut off scores. Because they know that a higher score typically indicates a higher caliber resident who will most likely complete residency and become board certified.

The stories we hear of residents getting fired are completely one sided. The article that was posted was junk.

The article about the former ENT resident talks vaguely about her residency performance. What were her in training scores etc? What was her fund of knowledge?

They paint a very obvious picture that a new PD came in and saw that she was a Black resident and somehow had it out for her.

To fire a resident for performance issues is not an easy or quick task. In a small residency like ENT, it disrupts the call schedule and it can throw off a programs accreditation if not enough residents are able to pass their boards etc.

If I found the correct residency program for UTMB ENT, there are only 15 total spots for residents (currently 14) and 6 are minorities.

Plus, throwing out raw numbers that 15% of dismissed residents are of a certain race isn't helpful. We need to control for other variables to see if race is the actual reason. The article doesn't discuss any of that.

And then suggesting that neurosurgery, plastics and derm are somehow purposely not taking in Black residents is a bit much. They want high class rank and high Step scores. It's not a difficult concept.

 

[anonperson]

So again, if it's SO obvious, please provide evidence supporting the idea that beyond a minimum level of competence, step scores are correlated with clinical performance besides "everybody knows it!" You're using circular logic - higher step scores mean you're a better doctors because everybody knows it to be true, seriously?

What do you think those "other variables" might be that we need to control for? Why do you think those variables are correlated with race?

I've asked you these same exact questions multiple times and you have repeatedly refused to answer and just reiterated the same arguments and logical fallacies. I don't really see a point in continuing to respond to you if you continue to do so.

Other variables that should be corrected for:
GPA, class rank, AOA status, in service exam scores just to name a few.

And I've asked you if there is racism why did it magically seem to skip East Asians, South Asian, middle Eastern people etc? Model minority BS is typically applied to East Asians, not your typically Indian or Pakistani person.

These racist White attendings are somehow okay with these very different races?

I don't need a double blinded randomized controlled trial to know that I need a parachute when I jump out of a plane.

Just like it's common sense that if I fill a residency class with AOA, 250+ Step 1 score residents, they will likely be stronger clinically than the class with all people who score 205 and are in the bottom quartile.

The bottom line is that the Statnews article is a literary Molotov cocktail to get people worked up just like the original post. Subjective assessments are apart of ANY field (law, medicine, tech etc). The United States as a whole is one of the most fair and equitable places in the world for minorities especially the field of medicine in 2022.

In general, residents who work hard, strive to improve and give a crap about their work routinely do well and have good careers regardless of race.

 

[operaman]

But the question of why black students/residents score lower is really the crux of the issue. I said what I think two possible answers could be, and if you think I'm missing a possible explanation please feel free to share it, but I think it's obvious that racism plays a role one way or another.

And I'll again push back on the idea that we have good data to suggest that test scores correlate well with anything other than other test scores and a MINIMUM level of competence. I have yet to see any, but if you've got evidence to the contrary I'd love to read it.

ETA: and again I have not seen anything suggesting these residents are being dismissed due to issues with test scores. It seems to be largely subjective factors which can certainly be affected by implicit bias at multiple levels. Which again comes back to the idea that unless you believe that URMs are inherently worse clinicians, you have to admit there is some external factor (eg racism in its various forms) influencing that disparity.

You’re definitely right that we don’t have data showing that test scores correlate well with clinical competence. The main issue is that clinical competence is ridiculously difficult to quantify. Doesn’t mean the relationship isn’t there - I certainly haven’t seen it disproved either - but I think it’s simply an impossible thing to measure effectively.

I don’t see a plausible explanation for how racism drives lower test scores other than that the URMs who would score higher simply aren’t applying to medical school. But of those that do apply, they clearly have lower knowledge base and lower aptitude as measured by the exams they took. Even if ills of society led to these inequities, it doesn’t alter the fact that the URMs entering med school do so with lower aptitude than others overall.

You’re right that the resident dismissals have little to do with test scores - most ent residencies don’t care much about ITE scores at all. I definitely know it wasn’t the issue in the linked article. I do think that it probably impacts the numbers reported by ACGME though, and it would be really easy to control for usmle and mcat scores and see if the attrition rate changes. In some ways, the fact those data are just sitting there and acgme hasn’t analyzed it suggests they probably did but didn’t want to publish what would be a highly unpopular result.

Where I think implicit bias drives attrition is when residents get in trouble. Not only is there the potential for faculty to see them as other, but they often lack the availability of good mentors who can help them remediate. I can think of one URM resident I saw get into hot water as an intern and who has since bounced back beautifully - a key factor was a URM faculty who took him under his wing, gave him assigned reading and met frequently to go over material and get him up to speed. I can imagine if he were in another program without such a faculty member, things may have gone differently.

 

[operaman]

Other variables that should be corrected for:
GPA, class rank, AOA status, in service exam scores just to name a few.

And I've asked you if there is racism why did it magically seem to skip East Asians, South Asian, middle Eastern people etc? Model minority BS is typically applied to East Asians, not your typically Indian or Pakistani person.

These racist White attendings are somehow okay with these very different races?

I don't need a double blinded randomized controlled trial to know that I need a parachute when I jump out of a plane.

Just like it's common sense that if I fill a residency class with AOA, 250+ Step 1 score residents, they will likely be stronger clinically than the class with all people who score 205 and are in the bottom quartile.

The bottom line is that the Statnews article is a literary Molotov cocktail to get people worked up just like the original post. Subjective assessments are apart of ANY field (law, medicine, tech etc). The United States as a whole is one of the most fair and equitable places in the world for minorities especially the field of medicine in 2022.

In general, residents who work hard, strive to improve and give a crap about their work routinely do well and have good careers regardless of race.

On that note, one of the best arguments against p/f step one came from a black colleague of mine. I’m personally in favor of p/f, but he was adamant that objective test scores were critical in letting him distinguish himself since he came from a disadvantaged background. He felt his mcat was critical in getting him into med school and that his high step 1 helped land him an ent spot at a top program.

It was definitely eye opening for me as I’m used to the whole “standardized tests are racist” schtick.

 

[HemeOncHopeful19]

Okay so then you are saying that URM residents are dismissed at a higher rate because they are inherently less likely to work hard, strive to improve, and give a crap about their work?

You keep trying to twist this situation into a statement about all “URM” (let’s call it what it is… black) residents but it isn’t. The vast majority of black residents finish their programs just fine and are fantastic doctors/colleagues/etc. People are individuals and there is no “inherently less likely to X” based on skin color, IMO.

The question they are posing is “is it possible that there is a small fraction of URM residents that have ended up overwhelmed in their programs due to affirmative action?”

I don’t know the answer but I think it’s interesting that it’s taboo to even bring it up.

 

[OptionOffense]

Why is racism tolerated in some or not all of residency programs in this country? I have heard of stories where a resident is either terminated or extended just because an attending is racist. Why is this tolerated in any residency?

racism is not illegal, discrimination is. I am NOT saying racism is ok, but y ou can be racist just as long as you dont discriminate.

 

[OptionOffense]

This is tough. I think the courts give a lot of leeway to medical educators to be stewards of the profession and to make decisions for the better interest of public safety. Where they sit, it is hard to question people who train physicians unless there is "hard evidence" that discrimination has occurred which often does not exist. These people are very good at covering their tracks. So it is hard to win a discrimination lawsuit against them.

Having gone through the medical education system and experienced troubles myself often times the soft skills are evaluated with more weight than the hard skills like operating, suturing and medical decision making. ANd those lacking in soft skills (me) will experience troubles. That being said obtaining soft skills is not that hard and is often not taught in residency. I learned through re-watching Mr. Rogers neighborhood all over again and becoming like Fred Rogers.

 

[guytakingboards]

It's a paradox.

URM candidates are recruited because they're thought to better possess the soft skills needed to serve the communities they come from.

However while going through training, they're held to the soft skill standards of the conservative establishment which has been shown to poorly serve those same communities.

If our goal is to increase diversity in medicine, then the field should be giving a longer rope to URM's not shorter. Isn't that one of the points of affirmative action? Give underrepresented communities an extra boost to level the playing field?

Obviously, easier said than done. A lot of training and education in the field needs to be done.

 

[operaman]

You keep trying to twist this situation into a statement about all “URM” (let’s call it what it is… black) residents but it isn’t. The vast majority of black residents finish their programs just fine and are fantastic doctors/colleagues/etc. People are individuals and there is no “inherently less likely to X” based on skin color, IMO.

The question they are posing is “is it possible that there is a small fraction of URM residents that have ended up overwhelmed in their programs due to affirmative action?”

I don’t know the answer but I think it’s interesting that it’s taboo to even bring it up.

There was some interesting literature on this at the undergraduate level a few years ago. I remember a whole “this American life” episode on NPR devoted to it. Essentially finding that many URM students who were admitted to elite schools with far lower scores than their classmates had incredibly high rates of attrition relative to other groups. I think we would be naive to assume the same thing isn’t happening at the med school and residency level. It probably doesn’t explain all the difference, but likely explains a substantial part.

 

[MDMechEngr]

Just take a look at the MCAT and gpa grid for medical school acceptance by race and you will know where the real racism resides. LOL.

 

[anonperson]

Okay and WHY do you think those variables are correlated with race?


Okay so then you are saying that URM residents are dismissed at a higher rate because they are inherently less likely to work hard, strive to improve, and give a crap about their work?

I'm not sure why you keep misinterpreting what is being written.

If some educator wanted to look at variables related to higher rates of attrition, they can easily do a case control study because they can compare dismissed residents to non dismissed residents.

The variables I mentioned have nothing to do with race but can confound any statistical results. If we want to see if race is the only statistically significant reason why URMs are fired at a higher rate, then it is obvious we need to account for these types of variables.

This has been examined in general surgery. If you take 2 seconds to review the abstract, they do a multivariate analysis to correct for other variables.

Desire to Leave at High-Attrition Residencies

Gifford et al determine how often categorical general surgery residents seriously consider leaving residency. At 13 residency programs, they administered an anonymous survey of 371 residents and 10-year attrition rates. Responses from those who seriously considered leaving were compared with...

jamanetwork.com

This is basic research design.

To that second point, where did I say URMs are inherently less likely to work hard.

You are purposely misreading.

What I am saying is residents who are fired are in general less competent and probably not good at their job, regardless of race. Are there some residents who are unfairly fired, sure, but that isn't the norm.

I can say that through my experience in residency and fellowship that the few residents who were fired (shockingly a white person was among them) were not that good and graduating them probably would have caused harm to the community.

 

[anonperson]

There was some interesting literature on this at the undergraduate level a few years ago. I remember a whole “this American life” episode on NPR devoted to it. Essentially finding that many URM students who were admitted to elite schools with far lower scores than their classmates had incredibly high rates of attrition relative to other groups. I think we would be naive to assume the same thing isn’t happening at the med school and residency level. It probably doesn’t explain all the difference, but likely explains a substantial part.

Academic mismatches

.

The Painful Truth About Affirmative Action

Why racial preferences in college admissions hurt minority students—and shroud the education system in dishonesty.

www.theatlantic.com

I know if I went to Cal tech or Harvard for undergrad, I'm pretty sure the average student at those schools would run circles around me academically.

 

[anonperson]

The variables you mentioned (AOA, test scores, etc. ) ARE correlated with race, as many in this thread have pointed out. Why do you think that is?

I'm not purposely misreading - I'm taking your argument to its logical next step and ASKING what you think the reason is that URMs are less likely to succeed in medicine, which you have not answered. URMs are dismissed from residency at a higher rate than their non-URM peers. Whether that is because of low test scores, being academically unprepared, socioeconomic factors, personality, racism, etc. - clearly there is SOMETHING different that is going on with URM residents. In my mind, there are two possible explanations - and again, feel free to provide another one if there's something I'm missing. 1) External factors, i.e. systemic and individual racism, cause URMs to be less successful in residency. 2) Internal factors, i.e. personality, drive, professionalism, intelligence, etc. are inherently worse among URMs and cause them to be less successful in residency. I know which I believe to be the case - which do you think it is?

To improve diversity, URMs are admitted to medical school with lower academic scores, on average. It is probably a bell curve distribution.

Why is it a stretch to think that students with lower scores will potentially struggle as the rigors of medical training increase?

If someone posted a study that was race blind but stated that medical students with lower MCAT scores, GPAs and Step scores were fired from residency at a higher rate , no one would bat an eye.

 

[anonperson]

Again, logical next step: why do URMs have lower academic scores?

Not my problem to figure out. I just want the best person for the job.

These are straightforward and fair tests on my eyes but apparently not to others.

Colleges have already started to ignore the SATs because the tests are deemed racist.

Might as well throw out Step 1/2/3, in service exams and board certification exams because according to some they can't tell us how competent a resident is. And can't do subjective feedback because there is so much implicit bias it can't be fair.

If you show up to residency and really really really want to be a doctor, that should be enough.

Having been out in the community working in a procedural specialty, I have unfortunately had to deal with physicians with poor skills who should have never graduated residency (of various races).

These physicians do real harm to real patients. And it's not the white patient with PPO insurance who gets affected, it's the poor minorities who get screwed over.

 

[OptionOffense]

Not my problem to figure out. I just want the best person for the job.

These are straightforward and fair tests on my eyes but apparently not to others.

Colleges have already started to ignore the SATs because the tests are deemed racist.

Might as well throw out Step 1/2/3, in service exams and board certification exams because according to some they can't tell us how competent a resident is. And can't do subjective feedback because there is so much implicit bias it can't be fair.

If you show up to residency and really really really want to be a doctor, that should be enough.

Having been out in the community working in a procedural specialty, I have unfortunately had to deal with physicians with poor skills who should have never graduated residency (of various races).

These physicians do real harm to real patients. And it's not the white patient with PPO insurance who gets affected, it's the poor minorities who get screwed over.

Doctors of all races harm patients. I would bet that the majority of the minority terminations are not for objective reasons rather subjective reasons. Thats where it gets sticky

 

[VA Hopeful Dr]

So again refusing to answer the question. Got it. I think the fact that you apparently can't even come to a conclusion that perhaps it is NOT an issue of inherent ability is interesting, to say the least.

It's probably not, and I don't believe he ever said it was.

It's probably at least in part due to race related issues: poverty, lack of support systems, unfamiliarity with the process (since they are less likely to know people who have successfully gone through the process) and so on.

 

[VA Hopeful Dr]

That's exactly my point. I'm saying think it's interesting that anonperson won't say that this is almost certainly the case, because the only alternative explanation I can think of is that they believe the disparities are due to inherent characteristics (which they haven't denied either).

Not commenting on it isn't the same as saying it's wrong.

 

[anonperson]

That's true, it's just weird to me that they immediately didn't say something like "of course black people aren't inherently worse doctors" when given multiple opportunities to do so and directly asked that question several times. I don't know them, I don't know their opinions/personality, maybe they have a good reason for not doing so, just making an observation.

I don't need to defend myself against your race baiting.

When did I ever say that black physicians were inherently worse based solely on their race? Feel free to point it out...

I don't feel the need to point out a minority physician can be competent because it's not a point of debate.

The crux of my argument is that your average URM is admitted with worse MCAT scores and GPAs. This likely carries over to Step scores and into residency for some students.

The bottom 10th percentile URM will be a weaker student than the bottom 10th percentile non URM.

This is not new or racist to acknowledge this.

So why would anyone be surprised if some of these medical students struggle in certain residencies?

You keep harping that if they score lower on standardized tests that still shouldn't determine competence. I disagree because all of Medicine is predicated on passing various tests as a surrogate for competence. It's not perfect but it works reasonably well for the vast majority of residents.

 

[OptionOffense]

I don't need to defend myself against your race baiting.

When did I ever say that black physicians were inherently worse based solely on their race? Feel free to point it out...

I don't feel the need to point out a minority physician can be competent because it's not a point of debate.

The crux of my argument is that your average URM is admitted with worse MCAT scores and GPAs. This likely carries over to Step scores and into residency for some students.

The bottom 10th percentile URM will be a weaker student than the bottom 10th percentile non URM.

This is not new or racist to acknowledge this.

So why would anyone be surprised if some of these medical students struggle in certain residencies?

You keep harping that if they score lower on standardized tests that still shouldn't determine competence. I disagree because all of Medicine is predicated on passing various tests as a surrogate for competence. It's not perfect but it works reasonably well for the vast majority of residents.

Is there a relationship between class rank and scores on standardized tests and quality as a physician.

 

[HemeOncHopeful19]

Is there a relationship between class rank and scores on standardized tests and quality as a physician.

I definitely think someone should study whether there is a relationship between these things and being dismissed from residency before they attribute it wholly to skin color.

 

[OptionOffense]

I definitely think someone should study whether there is a relationship between these things and being dismissed from residency before they attribute it wholly to skin color.

My contention is class rank and scores on standardized test have little correlation to what kind of doctor youre going to be as long as this low score, rank has nothing to do with work ethic and simply ( working with less aptitude).

 

[Apollyon]

My contention is class rank and scores on standardized test have little correlation to what kind of doctor youre going to be as long as this low score, rank has nothing to do with work ethic and simply ( working with less aptitude).

Well, there is the old joke: "What do you call the person who finishes last in their med school class? Doctor. What else do you call them? Defendant!"

 

[Raryn]

• "While Black residents account for about 5% of all residents, they accounted for nearly 20% of those who were dismissed in 2015, according to an unpublished analysis by the Accreditation Council for Graduate Medical Education."

You know, I had never actually seen data on what % of residents are dismissed, so this was a really interesting analysis to read. You can look at slide 42 of the linked analysis - there were between 198 and 277 residents fired in the US each year between 2004-2005 and 2015-2016. In that final year, 234 residents were dismissed, of which 46 were Black, non-Hispanic.

Looking up how many residents there are in the US during that time period shows that in 2015-2016 there were 120,598 active trainees (including fellows), of which 6,887 were Black. Click through to the PDF for the full data.

That means that approximately 46/6887 - or 0.67% - of Black residents were fired that year - compared to a rate of 0.2% overall. If we extrapolate out to over the course of a training period - which averages 4 years - rather than per year, then ~97% of Black trainees complete their residency compared to ~99% overall. This varies significantly per specialty - if you look at slide 44 of the initially linked document, the Black trainee pipeline dismissal was as high as 12.3% in Surgery or as low as 2% in Pediatrics, with White trainees ranging from 0.3% to 2.0%

That's simultaneously a relatively big and a relatively small difference. What percentage of the difference is racism? I have no idea. Certainly not zero. Probably not 100%.

 

[deleted1100659]

Some very easy points here that people aren't grasping.

1. My understanding is the number of white applicants is about 6x the number of african american applicants. When there is 6x the number of applicants, there are likely a higher number of candidates with a better academic background (in regards to numbers) to pick from. In order to create diversity by recruiting more of a minority population then you naturally have to be more lenient when it comes to numbers, because of the proportion of white applicants compared to minorities. Heck, looking at the data there were only around 100 native American applicants. Its incredibly unlikely that everyone from a certain group of people will be 90 percentile stats wise. There are top scoring applicants, middle of the pack, and lower scoring. So when you have for example, 100 native americans vs 25,000 white people, I would wager that they're are less top performing native americans applying, because there is a significantly larger candidate pool from the white group. Its just simply a numbers game. The people that get accepted with lower end stats, are likely to have a more uphill battle then someone who has a consistently strong record with courses/tests/etc. Unless the person with low scores has a pretty strong background in the medical industry.

2. The story seemed fairly subjective to me. I remember that female resident who supposedly was fired for "having cancer". When they released all the documents/evidence, it turns out there was quite a trail of evidence pointing towards her being a not so professional resident. I suspect there is more to the story with most (not all) cases.

3. most residency programs do everything in their power to keep you. On SDN residencies often get portrayed as malignant, but residencies don't like to fire people. It just makes them look bad and it only hurts the program. They usually have nothing to gain from doing so. Plus it opens them up to a lawsuit. Why would they stir the pot for no obvious reason? Im sure some malignant residencies programs exist, definitely, but as a whole most programs want to keep their residents.

 

[OptionOffense]

3. most residency programs do everything in their power to keep you. On SDN residencies often get portrayed as malignant, but residencies don't like to fire people. It just makes them look bad and it only hurts the program. They usually have nothing to gain from doing so. Plus it opens them up to a lawsuit. Why would they stir the pot for no obvious reason? Im sure some malignant residencies programs exist, definitely, but as a whole most programs want to keep their residents.

You dont understand. It is not the program per se that fires you, it is one particular person or several that have it out for you that trump up charges to get you out. That person could care less about reputation of the program, they just have it out for YOU, for whatever reason. There is a LOT of that I bet.

 

[deleted1100659]

You dont understand. It is not the program per se that fires you, it is one particular person or several that have it out for you that trump up charges to get you out. That person could care less about reputation of the program, they just have it out for YOU, for whatever reason. There is a LOT of that I bet.

if several people "have it out for you" then I would why multiple people are going out of there way to target you? is the problem you, or everyone else? Probability wise, which is more likely?

 

[Raryn]

There is a LOT of that I bet.

For a given value of a "LOT", given ~99% of trainees overall graduate the residency they start.

 

[OptionOffense]

For a given value of a "LOT", given ~99% of trainees overall graduate the residency they start.

Not compared to the overall number of graduates but I bet you if you really examine every single case of "resident gets dismissed" its all soft stuff that can go either way. Not every single case, but I would bet a majority

 

[Raryn]

Not compared to the overall number of graduates but I bet you if you really examine every single case of "resident gets dismissed" its all soft stuff that can go either way. Not every single case, but I would bet a majority

I only knew a handful of residents that got dismissed over the course of years of training, and can't think of any cases that weren't justified. Three come to mind immediately. One lost his license after being caught sleeping with a patient (among other shenanigans), one was grossly incompetent to the point where we felt unsafe having him care for patients without direct supervision even 6 months into intern year, and one had a drug issue. None were under-represented minorities.

I can't speak to a majority being potentially unjustified.

 

[deleted1100659]

I only knew a handful of residents that got dismissed over the course of years of training, and can't think of any cases that weren't justified. Three come to mind immediately. One lost his license after being caught sleeping with a patient (among other shenanigans), one was grossly incompetent to the point where we felt unsafe having him care for patients without direct supervision even 6 months into intern year, and one had a drug issue. None were under-represented minorities.

I can't speak to a majority being potentially unjustified.

Same experience here. We had one resident fail a UDS multiple times, not show up to call, using substances while at work, lying about patient care, entering false things in progress notes, etc and he still was given multiple chances before finally they had to let him go because he was going to kill someone if they let him continue. Me and all the other residents were shocked he even made it that long and pretty much everyone thought he had no place in medicine. Another coresident back in the day routinely showed up late by 1-2 hours for work and they still graduated through just fine. So yeah I have a hard time believe residency programs enjoy going through the effort of dismissing someone why would they even want to deal with all the stress/paperwork/potential liability that can bring?

 

[anonperson]

You dont understand. It is not the program per se that fires you, it is one particular person or several that have it out for you that trump up charges to get you out. That person could care less about reputation of the program, they just have it out for YOU, for whatever reason. There is a LOT of that I bet.

So several of a residents supervising attendings think they are not fit to continue...

You think the attendings are the problem and not the resident?

Sure, a certain percentage of these firings are unfair but I'm willing to bet most are justified. Can I prove it, no, but anecdotally the firings I have seen were warranted.

 

[Emmet2301]

I don't need to defend myself against your race baiting.

When did I ever say that black physicians were inherently worse based solely on their race? Feel free to point it out...

I don't feel the need to point out a minority physician can be competent because it's not a point of debate.

The crux of my argument is that your average URM is admitted with worse MCAT scores and GPAs. This likely carries over to Step scores and into residency for some students.

The bottom 10th percentile URM will be a weaker student than the bottom 10th percentile non URM.

This is not new or racist to acknowledge this.

So why would anyone be surprised if some of these medical students struggle in certain residencies?

You keep harping that if they score lower on standardized tests that still shouldn't determine competence. I disagree because all of Medicine is predicated on passing various tests as a surrogate for competence. It's not perfect but it works reasonably well for the vast majority of residents.

Even if URMs are being admitted with worse MCAT scores/GPA it also begs the question whether or not they're receiving adequate support to "catch" up to their peers with higher MCAT/GPAs. Not to mention URMs usually having a different "cultural mindset" that might not match their usually white PD/attending expectations. This is one of the reasons they encourage minorities into leadership/mentorship positions so they can provide their own "cultural viewpoints" into the mix.

(Also, Indians (and usually Pakistanis as well) are absolutely included in the model minority myth. Heck Indians are like the second highest earning group in the US.)

 

[operaman]

Not compared to the overall number of graduates but I bet you if you really examine every single case of "resident gets dismissed" its all soft stuff that can go either way. Not every single case, but I would bet a majority

Having to agree with my colleagues that this simply isnt true. Firing a resident is a huge deal and one person with a grudge would be hard pressed to do it, and they risk a lot of professional blowback as well. The due process requirements imposed on firing for competence typically mean you need multiple faculty stating in writing that someone is unfit to continue their training and cannot be remediated. You really do need a critical mass of people against you.

Oddly enough, most fired residents can point to a handful of good evaluations and they often lean on these to claim all the others are biased. Even the worst residents will typical vibe well with at least one person along the way, but that doesn’t mean the others are wrong.

As I think about all the residents I know who got canned, I can’t think of one who didn’t absolutely deserve it. Some of them were just terrible human beings, and other were very kind people who simply couldn’t keep up with a rigorous program. In all cases they were given ample written warning that things were going awry and yet they either unwilling or unable to fix the issues.

 

[deleted1100659]

Even if URMs are being admitted with worse MCAT scores/GPA it also begs the question whether or not they're receiving adequate support to "catch" up to their peers with higher MCAT/GPAs.

How would you even accomplish this though? I dont fully understand what you're going for, would this apply to everyone such as caucasian/asian/etc o with low stats or just minorities? I don't even think your college background plays a big factor in how well you do in medical school, as a lot of the people who went to ivy league colleges struggled. I went to a small/cheap university was top half of my class. Its how well people adapt to medical school, I dont necessarily see that as a race thing. I cant think of one time my prior education background gave me any advantage in medical school. I still spent 12 hours a day in the library many days. Many minority students were at the top of my class back in my day because they had a strong work ethic.

It is a much more complex equation then that. I think the issue is many minority families are stuck in the circle of poverty which is hard to escape. I think this is what limits the number of minority applicants into grad programs. Perhaps it starts with simple interventions such as improving school systems, and making better schools more accessible to all in a fair way. Among other things.

 

[doctalaughs]

Do you think affirmative action may play a role in why we see higher terminations of black residents and that resident in particular?

I see there was no mention of some objective data like MCAT scores, usmle scores and in-training scores compared to other ENT residents. Which I think is telling since the article was so one-sided and mentioned a “perfect SAT” I would think they would add those (only) objective data if it was in their favor.

Food for thought.

Or maybe the PD was a flaming racist. No way to know given the trash data and trash reporting and trash citing of silly studies with no analytical ability to think of various possibilities.

 

[OptionOffense]

. Firing a resident is a huge deal and one person with a grudge would be hard pressed to do it,. The due process requirements imposed on firing for competence typically mean you need multiple faculty stating in writing that someone is unfit to continue their training and cannot be remediated. You really do need a critical mass of people against you.

Oddly enough, most fired residents can point to a handful of good evaluations and they often lean on these to claim all the others are biased. Even the worst residents will typical vibe well with at least one person along the way, but that doesn’t mean the others are wrong.

As I think about all the residents I know who got canned, I can’t think of one who didn’t absolutely deserve it. Some of them were just terrible human beings, and other were very kind people who simply couldn’t keep up with a rigorous program. In all cases they were given ample written warning that things were going awry and yet they either unwilling or unable to fix the issues.

We will have to agree to disagree. One person in power can absolutely unilaterally make a case for dismissing someone. The due process requirements are non existant. This isnt a criminal trial. Residency is a contract, you give enough notice, I do not have to give you a reason why I am firing you. Residency programs abuse this. Try reporting your hours accurately and see if you dont get ****-canned. Classic cases of retaliation. I am not saying your examples do not exist. There are absolute sociopaths that need to be dismissed but my examples exist not infrequently.

 

[deleted1100659]

my examples exist not infrequently.

But objectively that cant be true since most residents graduate just fine, looking at the numbers. It is not frequent at all to get dismissed from residency.

 

[OptionOffense]

But objectively that cant be true since most residents graduate just fine, looking at the numbers. It is not frequent at all to get dismissed from residency.

[Of those dismissed] the reasons i cited exist not infrequently.

 

[operaman]

We will have to agree to disagree. One person in power can absolutely unilaterally make a case for dismissing someone. The due process requirements are non existant. This isnt a criminal trial. Residency is a contract, you give enough notice, I do not have to give you a reason why I am firing you. Residency programs abuse this. Try reporting your hours accurately and see if you dont get ****-canned. Classic cases of retaliation. I am not saying your examples do not exist. There are absolute sociopaths that need to be dismissed but my examples exist not infrequently.

I would encourage you to read through any program’s handbook and policies from their ACGME office about the process for terminating a resident. There is absolutely a due process, just different from that of the criminal justice system. There are some offenses that trump due process, but most things require some kind of written notice, remediation, etc.

I’m sure some retaliation has happened, but it’s exceedingly rare. No matter how much one person hates a resident, you still have to justify your decisions to all your fellow faculty. If you try to can someone they all think is great, it could backfire and you might find yourself having a meeting with your chairman.

It also creates a big risk for your program as too many firings will dissuade top applicants from applying for a few cycles. Privately I’ve heard this from a few faculty that they started dropping lower on their rank list after terminating a couple residents.

 

[OptionOffense]

No matter how much one person hates a resident, you still have to justify your decisions to all your fellow faculty.

Do you actually think it is that hard to justify getting rid of a resident? Why do you think everyone is scared ****less about saying anything against their program? Because they know how subjective these things are and irregardless of how great a person is, it can ALWAYS be justified easily. All you need is a couple of people on board, a couple of staff complaints which we all have, and voila..

 

[mvenus929]

Do you actually think it is that hard to justify getting rid of a resident? Why do you think everyone is scared ****less about saying anything against their program? Because they know how subjective these things are and irregardless of how great a person is, it can ALWAYS be justified easily. All you need is a couple of people on board, a couple of staff complaints which we all have, and voila..

I don't think anyone is saying this doesn't happen. But I doubt it happens that much. Most residency programs are run by good people who want to train good physicians. They're not going to fire someone for no reason. Unless someone has gross misconduct, you do need a process, especially if you're trying to fire them for incompetence.

Out of the residents I've known to be fired, 1 had a drug problem, 1 was in remediation for a year and a half (out of a 3 year program) before finally being told that they weren't meeting milestones and maybe another field would be better, and 1 was extremely intelligent, but couldn't apply knowledge to the patient in front of them... and also went through 3 months of probation and some intensive supervision before that and was deemed to not be safe to supervise. The latter of the three probably felt they were being targeted, but the concerns were still there and witnessed during supervision. They also went on to complete another program elsewhere with more of a primary care focus.

I knew another 4 residents that were also in remediation or on probation that successfully completed the program. And had I not been in a leadership positions, I probably wouldn't have known about a couple of those.

 

[VA Hopeful Dr]

I don't think anyone is saying this doesn't happen. But I doubt it happens that much. Most residency programs are run by good people who want to train good physicians. They're not going to fire someone for no reason. Unless someone has gross misconduct, you do need a process, especially if you're trying to fire them for incompetence.

Out of the residents I've known to be fired, 1 had a drug problem, 1 was in remediation for a year and a half (out of a 3 year program) before finally being told that they weren't meeting milestones and maybe another field would be better, and 1 was extremely intelligent, but couldn't apply knowledge to the patient in front of them... and also went through 3 months of probation and some intensive supervision before that and was deemed to not be safe to supervise. The latter of the three probably felt they were being targeted, but the concerns were still there and witnessed during supervision. They also went on to complete another program elsewhere with more of a primary care focus.

I knew another 4 residents that were also in remediation or on probation that successfully completed the program. And had I not been in a leadership positions, I probably wouldn't have known about a couple of those.

My program lost 3 while I was there. 1 was an intern who kept oversleeping at home or falling asleep and not able to be woken up while on call. Refused evaluation for this.

1 was an intern who lied about his apartment catching fire to get out of a call shift. Also dated a nurse, when they broke up he got a bit obsessive.

The third I have no idea, he was a 2nd year let go 2 months into my intern year.

I was on probation and graduated just fine. Probably others but I wouldn't know about it.

 

[OptionOffense]

Most residency programs are run by good people who want to train good physicians.

That's why people rave about residency programs so much because they are run by good people!!! Dude, get your head out of your rear, please!!

 

[VA Hopeful Dr]

That's why people rave about residency programs so much because they are run by good people!!! Dude, get your head out of your rear, please!!View attachment 356774

Plenty of us do rave about our residency programs.

And even residency programs that people hate don't often fire people. My wife to this day still talks about how awful her program was, but no one was fired while she was there.

 

[VA Hopeful Dr]

Surprised to hear you were on probation. Was it for a long time? Probation seems to be equivalent to ‘about to get fired’ on here so it’s always good to hear about people who made it to the other side!

Oh yeah, super close to being fired.

I was sick the first week of a 2 week elective. I didn't show up and I didn't call to let anyone know. 27 year old me was a remarkable *******.

I was told at the time basically "one more screw up and you're out, but if you do well the next 2.5 years this gets erased and its like it never happened". I did well and busted my tail with extra stuff. I worked almost every holiday, I was first to volunteer if someone needed a shift covered at the last minute, took a particular interest in teaching interns my 2nd and 3rd year, kicked butt on ITEs, you get the idea.

 

[guytakingboards]

I mean kind of insane you got put on probation for that. Not like you were out in Vegas doing hookers and blow.

Really? Not showing up for a solid week? That's problematic in any program.

 

[guytakingboards]

Based on his explanation a warning would of been more than sufficient. Not like he was just chilling at home. It was an elective. Dude was sick and forgot to tell someone. Big effing deal. The lists of things people have done in residency and not even got a warning for far exceeds his bone headed mistake

??? It's exactly like he was chilling at home. He was literally at home. For 9 days, he couldn't take 20 sec to email/call/text anyone?!?

The absolute most basic tenet of any job is: show up. To fail to do so for a week, with an explanation only after the fact, is gonna get you in hot water every time.

 

[voxveritatisetlucis]

??? It's exactly like he was chilling at home. He was literally at home. For 9 days, he couldn't take 20 sec to email/call/text anyone?!?

The absolute most basic tenet of any job is: show up. To fail to do so for a week, with an explanation only after the fact, is gonna get you in hot water every time.

I agree. Pretty sure one would be fired from most jobs after not showing up for a week without explanation