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The Case of Dr. X

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The Case of Dr. X. Background. Transfer from another program to your PGY2 year USMLE Step 1 & 2 scores 200 range “Highly recommended” with superior clinical competence, knowledge base, and maturity Chair Letter: Will excel in your program. First Rotation - Elective.

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Presentation Transcript
background
Background
  • Transfer from another program to your PGY2 year
  • USMLE Step 1 & 2 scores 200 range
  • “Highly recommended” with superior clinical competence, knowledge base, and maturity
  • Chair Letter: Will excel in your program
first rotation elective
First Rotation - Elective
  • Satisfactory, but presentation skills need improvement
  • Trouble organizing the case and coming up with differential diagnosis
second rotation hematology oncology ward
Second Rotation – Hematology/Oncology Ward

Nursing concerns surface over his responses and reactions to calls and are reported to Chief Residents:

  • High K+ - didn’t respond readily
  • Febrile neutropenic patient, nurse identifies possible tunnel catheter skin infection – resident unconcerned, fellow had to initiate management
second rotation hematology oncology ward cont d
Second Rotation – Hematology/Oncology Ward (cont’d)
  • Irregular heart rhythm detected in patient being transported to radiology after multiple failed LP attempts – “I am not concerned, he just got poked several times in his back”. Patient experiences oxygen desaturation after procedure!
second rotation hematology oncology ward cont d1
Second Rotation – Hematology/Oncology Ward (cont’d)
  • GI fellow concerns about team performance regarding a patient with GI bleed
  • End-of-month evaluations from teaching attending and intern do not allude to significant concerns
  • Chief Residents counsel Dr. X: casual responses are inappropriate with regard to acuity of illness seen in this hospital
fourth rotation night float
Fourth Rotation – Night Float
  • No problems reported by intern
  • Some residents on day teams expressed concern to Chief Residents regarding:
  • Aspects of judgment
  • Ability to prioritize patient problems
  • Breadth of differential diagnosis
fifth rotation inpatient medicine
Fifth Rotation – Inpatient Medicine
  • Teaching attending evaluation: well-organized, team run well, added to quality of discussions about cases, sought feedback
fifth rotation inpatient medicine cont d
Fifth Rotation – Inpatient Medicine (cont’d)
  • Intern evaluations:
  • Appeared to be self-motivated to learn more about medicine and demonstrated an interest in teaching.
  • Not especially strong at applying knowledge to clinical situations.
fifth rotation inpatient medicine cont d1
Fifth Rotation – Inpatient Medicine (cont’d)
  • More interested in looking for “zebras” than delivering good basic care.
  • Had somewhat limited first-hand knowledge of our patients.
  • Don’t think he passes the basic test “would you want this person to provide care for one of your loved ones?”
sixth rotation micu
Sixth Rotation - MICU

Attending comments during and after the month:

  • Dr. X had difficulty quickly assessing and implementing care on critically ill patients
  • At times sloppy with data gathering and reporting
  • Oral presentations poorly organized and often mumbles and does not engender confidence in the listener
sixth rotation micu cont d
Sixth Rotation – MICU (cont’d)
  • Written communication often sloppy and illegible
  • Poor organizational skills, confusing presentations, make it difficult to follow his thought processes
  • Needs substantial work at presentation skills, formulating and expressing assessments and plans, learning a problem- and systems-oriented approach to patient care
sixth rotation micu cont d1
Sixth Rotation – MICU (cont’d)
  • Earnest, hard-working, cares about patients

Bottom line: We have serious concerns about his ability to function as a senior resident, and believe he should repeat the rotation

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